Comparing two ways to give breathing support to adults with very low blood oxygen
Compares mask pressure oxygen with high-flow nasal oxygen in adults with acute respiratory failure.
Plain-language title generated from the registry record
Registry title: WIN Ratio Analysis to Determine a Strategy of Non- Invasive SUpport for Respiratory Failure in the EmeRgency Department
Key facts
- Where
- Ann Arbor, Columbus, Murray, New Haven, Philadelphia, Seattle, Tucson, and Winston-Salem, United StatesSee the 9 sites
Where in United States
- University of Michigan Medical CenterAnn Arbor, United StatesTaking people
- Ohio State East HospitalColumbus, United StatesTaking people
- OSU Wexner Medical CenterColumbus, United StatesTaking people
- Intermountain Medical CenterMurray, United StatesTaking people
- Yale New Haven HospitalNew Haven, United StatesTaking people
- Temple University HospitalPhiladelphia, United StatesTaking people
- Harborview Medical CenterSeattle, United StatesTaking people
- Banner University Medical Center - TucsonTucson, United StatesTaking people
- Wake Forest Baptist Medical CenterWinston-Salem, United StatesTaking people
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- Ohio State University
- Trial code
- NCT07558265
- Record updated
- 5 November 2026
- Original description
The purpose of this clinical trial is to determine the best initial non-invasive respiratory support (NIRS) strategy for adults who present to the emergency department with acute hypoxemic respiratory failure, a condition in which blood oxygen levels are dangerously low and require urgent treatment. This study compares two commonly used non-invasive respiratory support strategies to evaluate their effectiveness and safety, based on important patient outcomes during hospitalization, including survival, the need for invasive mechanical ventilation, and the duration of respiratory support. Participants will be randomly assigned (with an equal chance) to receive one of the following treatments:Read full original descriptionShow less
WIN Ratio Analysis to Determine a Strategy of Non- Invasive SUpport for Respiratory Failure in the EmeRgency Department
The purpose of this clinical trial is to determine the best initial non-invasive respiratory support (NIRS) strategy for adults who present to the emergency department with acute hypoxemic respiratory failure, a condition in which blood oxygen levels are dangerously low and require urgent treatment. This study compares two commonly used non-invasive respiratory support strategies to evaluate their effectiveness and safety, based on important patient outcomes during hospitalization, including survival, the need for invasive mechanical ventilation, and the duration of respiratory support. Participants will be randomly assigned (with an equal chance) to receive one of the following treatments:
* Non-Invasive Positive Pressure Ventilation (NIPPV): Oxygen delivered under pressure through a face mask. * High-Flow Nasal Oxygen (HFNO): Oxygen delivered at high-flow through a specially designed nasal cannula placed in the nostrils.
Researchers will compare the two treatment strategies using a hierarchical assessment of major pulmonary outcomes, including:
* Hospital survival * Days on mechanical ventilation * Duration of non-invasive respiratory support
As part of the study, researchers will collect:
* Blood and urine samples * Physiologic measurements (such as chest movement measured through sensors placed on the skin) * Information from participants' medical records
Inclusion: Age ≥18 years; Presenting to the Emergency Department (ED) with Acute Hypoxemic Respiratory failure (AHRF), defined as:; [(respiratory rate ≥25 breaths/min) AND (requiring ≥6 L/min of oxygen required to maintain SpO2 ≥90%), OR SpO2:FiO2 ratio<250] OR; Arrival at ED on prehospital Non-Invasive Respiratory Support (NIRS); Clinical need for NIRS; Randomization ≤2 hours after identification of need for NIRS; Randomization ≤6 hours of ED arrival.
Exclusion: Previous enrollment in WINDSURFER; Cardiac arrest; Home use of non-invasive positive-pressure ventilation for respiratory support of a medical condition other than sleep apnea; History of advanced chronic obstructive pulmonary disease; History of advanced heart failure; Urgent need for intubation; Respiratory arrest; Patient not located in the ED; Craniofacial anatomic features that prohibit either Non-Invasive Positive Pressure Ventilation (NIPPV) or High Flow Nasal Oxygen (HFNO) interface; Tracheostomy or laryngectomy stoma; Hemodynamic instability requiring >0.2mcg/kg/min of norepinepherine (or equivalent) to maintain mean arterial pressure >65mmHg; Pre-existing "do not resuscitate" or "do not intubate" order; Transferred from another Emergency Department; Presence of opt-out identification; Prisoner; Known or apparent pregnant; A patient-specific contraindication makes one assigned study intervention unsafe.