Non-invasive ventilation (NIV) is recommended for immunocompromised patients with acute respiratory failure in the ICU. However, it can have harmful effects. High-flow nasal oxygen (HFNO) alone could be an alternative strategy to reduce mortality. 

The HFNC Alone or Associated With NIV for Immunocompromised Patients Admitted to ICU for Acute Respiratory Failure (FLORALI-IM) study was conducted in 29 ICUs in France and Italy (28 in France and one in Italy). The study included adult immunocompromised patients with acute respiratory failure. Patients were randomly assigned to HFNO alone or NIV alternating with HFNO. 

Patients in the HFNO alone group were treated by HFNO with a gas flow rate of 60 L/min or the highest tolerated, while in the NIV group, patients were treated with a first session of NIV for at least four hours followed by sessions for a minimal duration of 12 hours a day. NIV sessions were interspaced with HFNO.