How effective is high-flow nasal cannula therapy at preventing endotracheal intubation in adults?

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Why is this study important?

Acute respiratory failure (ARF) is a common reason for patient transfer from the emergency department (ED) to the intensive care unit (ICU). While noninvasive positive pressure ventilation (NIPPV) has been proven effective at avoiding endotracheal intubation (ETI) and improving clinical outcomes, it is not without limitations. High-flow nasal cannula (HFNC) oxygen (O2) is well tolerated in children but whether it is as effective in adults as NIPPV at reducing ETI is unknown.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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