الفهرس 
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Abstract
Summary
Acute respiratory failure is a serious condition, which leads to marked intensive care unit admissions and it is associated with a high mortality (Ni, Luo et al. 2017).
It was reported that approximately half of the patients with acute respiratory failure often required endotracheal intubation and mechanical ventilation which is associated with an increase in length of hospital stay, medical expense, various adverse events such as barotrauma and ventilator-associated pneumonia, and high hospital mortality So, avoiding endotracheal intubation is essential or finding an alternative aiming to reduce the mortality (Stefan, Shieh et al. 2013).
Although the use of noninvasive ventilation strategy as a respiratory supportive therapy had improved the clinical outcomes as relative reduction in the rate of endotracheal intubation, ICU stay and mortality, (Ferrer, Esquinas et al. 2003, Keenan, Sinuff et al. 2004, Rochwerg, Brochard et al. 2017) unfortunately, noninvasive ventilation failure has been reported to occur in about 40% in ARF patients with a number of adverse effects (Esteban, Ferguson et al. 2008) So, searching for effective alternatives to noninvasive ventilation is required.
High flow nasal cannula is a promising new oxygen supply device allowing FiO2 delivery up to 100% and flow rate up to 60 L/min. HFNC offers significant advantages as gas warming and humidification, constant fraction of inspired oxygen, anatomical dead space washout, positive nasopharyngeal pressure, improvement of improved mucociliary clearance. So it seems a reasonable alternative to noninvasive ventilation (Nishimura 2015).
Our study is a clinical randomized observational study which was conducted on 40 patients with acute hypoxemic respiratory failure admitted to the critical care department and chest department in Beni-Suef university hospital during the period from August 2018 till November 2019.
Patients were divided into 2 groups; (group A) included 20 patients were subjected to high flow nasal cannula and (group B) included 20 patients who were subjected to noninvasive ventilation.
The aim of the study was to evaluate the effectiveness of high-flow nasal cannula (HFNC) in reducing the rate of endotracheal intubation in adult patients with acute hypoxemic respiratory failure in comparison to noninvasive ventilation (NIV).
The study results showed no statistical significant difference between the two groups regarding the clinical endpoints (intubation rate, mortality or ICU stay). However, NIV had a statistically significant increase in PaO2/FiO2 ratio.
We noticed a significant difference regarding tolerance and patients comfort as HFNC has higher tolerance than NIV.
Our study demonstrated that there was a statistical significant difference between patients who needed intubation and who didn’t need intubation regarding ROX index (P-value <0.001). With ROC Curve analysis for prediction of success or failure of HFNC a cut off value less than or equal 4 of the ROX index, it can predict the failure of the HFNC with 66.67% sensitivity and 76.47% specificity.