N Engl J Med

High-flow oxygen fails to improve survival in acute hypoxemic respiratory failure

March 20, 2026

In the multicenter, open‑label, randomized SOHO trial, 1,110 adults with acute hypoxemic respiratory failure (PaO₂/FiO₂ ≤200, tachypnea, and pulmonary infiltrates) were assigned to high‑flow nasal oxygen or standard oxygen therapy. By day 28, mortality was identical in both groups (14.6%). However, intubation occurred less often with high‑flow oxygen (42.4% vs. 48.4%). Serious adverse events during spontaneous breathing were uncommon but numerically higher with high‑flow therapy.

Clinical takeaway: Consider use of high‑flow nasal oxygen as a first‑line supportive strategy to improve comfort and potentially reduce intubation, but do not expect a mortality benefit over well‑delivered standard oxygen in unselected ICU patients with acute hypoxemic respiratory failure.

Source:

Frat JP, et al; SOHO Trial Group and the REVA Network. (2026, March 17). N Engl J Med. High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure. https://pubmed.ncbi.nlm.nih.gov/41841715/