Ohio State researchers to lead $12 million national effort to improve emergency respiratory care

Oxygen, our most basic need. But when you lack the adequate amount, it becomes a life-threatening symptom of many medical conditions, including respiratory failure. Dangerously low levels of oxygen in the blood, also known as hypoxemia, cause the deaths of more than 100,000 people in the United States annually. But now, a $12 million award from the National Heart, Lung and Blood Institute will help researchers at The Ohio State University College of Medicine conduct a clinical trial to test the best treatment for patients with acute hypoxemic respiratory failure (AHRF). 

Henry E. Wang, MD, MPH, the trial’s lead researcher and a clinical professor in the Department of Emergency Medicine at the Ohio State College of Medicine, explains how this national study, titled “WIN ratio analysis to Determine a strategy of non-invasive SUpport for Respiratory Failure in the EmeRgency Department (WINDSURFER),” will be the first head-to-head comparison of the delivery of high-flow nasal oxygen (HFNO) through a specially designed nasal tube with more recognized treatments like bilevel positive airway pressure (BiPAP), which delivers high-pressured oxygen through a tight-fitting face mask. 

“HFNO rapidly gained recognition in emergency departments in the United States as a vital treatment for COVID-19, offering a noninvasive alternative to traditional oxygen delivery methods,” Dr. Wang says. “This study represents a major step forward in how we care for patients with respiratory failure in the emergency setting.” 

Existing research shows that HFNO improved oxygenation and shortened hospital stays, while BiPAP enhances ventilation by increasing the pressure during inhalation and decreasing it during exhalation.  

This trial will be conducted through a National Institutes of Health-funded research consortium called Strategies to Innovate Emergency Care Clinical Trials Network (SIREN), which is dedicated to advancing emergency and critical care. SIREN consists of more than 75 hospitals and academic medical centers who conduct high-impact clinical trials due to its robust regulatory framework, community engagement strategies and real-time data monitoring systems. 

“The trial will enroll approximately 500 patients across SIREN sites nationwide,” Dr. Wang says of WINDSURFER. “By leveraging the national reach of the SIREN network and a patient-centered design, we aim to generate definitive evidence that will guide clinical practice across the country.” 

Lai Wei, PhD, is a clinical associate professor in the Department of Biomedical Informatics, and she leads the Clinical Trials Division within the Center for Biostatistics, both in the College of Medicine. Her extensive collaborative research experience in clinical trial design, including adaptive and other novel designs, will help her lead this  study’s biostatistical team.  

Wei will also hold a role as co-leader of the data coordinating center, in collaboration with the Medical University of South Carolina. Other collaborating institutions include the University of Arizona, Baystate Medical Center in Springfield, Massachusetts, and the University of Michigan. The WINDSURFER trial is a crucial step needed to help discover what combination of noninvasive and invasive strategies will work best to effectively manage AHRF. The results have the potential to further develop strategies using precision medicine that can be applied to an AHRF patient’s specific condition and clinical situation.