🫁 High-flow nasal oxygen in acute hypoxemic respiratory failure: does it really change outcomes? The SOHO Trial, published in NEJM, randomized 1,116 patients with acute hypoxemic respiratory failure (PaO₂/FiO₂ ≤200, RR >25/min and pulmonary infiltrates) to high-flow nasal oxygen (HFNO) or standard oxygen therapy. The results deserve attention: 🔹 28-day mortality: 14.6% vs 14.6% — no difference. 🔹 Intubation by day 28: 42.4% with HFNO vs 48.4% with standard oxygen — an absolute difference of ~6 percentage points. For me, the clinical message is important: HFNO may help avoid intubation in some patients, but avoiding intubation is not synonymous with improving survival. And this brings us back to physiology. In the ED, HFNO should not become a destination. It is a therapeutic trial that requires close and repeated reassessment of oxygenation, respiratory rate, work of breathing and clinical trajectory. The real challenge is not simply deciding HFNO vs standard oxygen. It is recognizing who is responding—and, crucially, when non-invasive support is failing and intubation should no longer be delayed. 📚 Frat JP et al. High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure. N Engl J Med. 2026;394:2095-2106. DOI: 10.1056/NEJMoa2516087. @DiegoEscarraman @javier20ch @MarlonVFZR @DrCriticalCare @drkeithsiau @franciscojlk @Dr_Dive @dasairway @911EDiaz @SOMELaguna @SEmergencistas @SafeAirway @SMMEAC @IhabFathiSulima @Anaes_Journal @NEJM @anesthesianews @italo05airway @JackelineEstof1 @OrlandoRPN