Early administration of oxygen via high-flow nasal cannula is associated with better outcomes in the most severely immunocompromised patients with acute respiratory failure (ARF) admitted to intensive care units. This is one of the key findings of the international EFRAIM III study — one of the largest studies ever conducted in intensive care medicine, now published in The Lancet Respiratory Medicine—which included the participation of Professor Pedro Póvoa, Dean of NOVA Medical School, as a member of the research team.
The study analysed data from nearly 10,000 critically ill immunocompromised adult patients admitted to 103 intensive care units across 26 countries, including Portuguese patients treated in the ICUs of the Unidade Local de Saúde de Lisboa Ocidental, alongside contributions from other local investigators.
The findings show that the underlying disease, the cause of ARF, and the initial ventilatory support strategy are associated with 30-day mortality and the need for intubation. In addition, the results suggest improved clinical outcomes compared with previous studies and indicate that tracheal intubation should no longer be considered futile in these patients. Among the many risk factors for mortality identified in the study, several are potentially modifiable. Although further research is needed, the findings support changes aimed at reducing mortality, including improved diagnostic strategies to reduce the number of patients with an unidentified cause of ARF, earlier ICU admission, and the early use of high-flow nasal oxygen therapy.
The study also identified the main risk factors for mortality and the need for intubation, including the presence of coma on admission, severe fungal infection, the need for vasopressor support, and acute kidney injury, while confirming the benefits of early administration of high-flow nasal oxygen therapy.
The research also confirms another important trend: patients are now recovering better than they were just a few years ago. This clearly reflects not only the progress made in intensive care medicine but also the value of an individualised, evidence-based therapeutic approach for critically ill immunocompromised patients. This progress has even led the researchers to conclude that intubation—once approached with considerable caution in this patient population—can now make a meaningful difference and help save lives.
“These findings allow us to assess each patient’s risk more accurately and make better-informed decisions earlier. Ultimately, they help us tailor treatment to the individual rather than applying the same approach to everyone,” said Pedro Póvoa, Dean of NOVA Medical School, Head of ICU 4 at the Intensive Care Department of Hospital de São Francisco Xavier, and one of the study’s investigators.
Portuguese intensive care medicine will also be in the spotlight at the 39th Annual Congress of the European Society of Intensive Care Medicine (ESICM LIVES 2026), taking place from 10–14 October 2026 at the Lisbon Congress Centre. Professor Pedro Póvoa, who serves on the ESICM Education and Training Committee, will contribute to several sessions dedicated to healthcare professional education, further reinforcing the role of NOVA Medical School and Portugal in training the next generation of intensive care specialists.