Abstract:Objective To compare the clinical effects of high-flow nasal cannula （HFNC） oxygen therapy and non-invasive mechanical ventilation （NIV） after extubation from invasive mechanical ventilation （IMV） in the patients with acute heart failure （AHF）. Methods From July 2018 to June 2021, 123 AHF patients were enrolled in a prospective randomized controlled study, who were successfully weaned off the （IMV） at 9 ICUs in Nanjing. The patients were randomly divided into HFNC group （n=63） and NIV group （n=60） by use of a computer-generated table of random numbers. The clinical data for all patients were reviewed, and the main outcome measures, secondary outcome measures and adverse events were evaluated and compared between two groups. Results There was no statistical difference in general clinical data, etiology, complications and echocardiographic measures between two groups（P＞0.05）. There was no significant difference in re-intubation rate （6.3% vs 6.7%）, length of ICU stay ［8（6，10）d vs 7（5，10）d］, total hospital stay ［（17.5±4.5）d vs （16.6±7.0）d］ and in-hospital mortality （11.1% vs 10.0%） between HFNC group and NIV group（P＞0.05）. The incidences of nasal bridge skin damage （10.0% vs 0） and gastrointestinal flatulence （15.0% vs 0） in NIV group were significantly higher than those in HFNC group （P＜0.01）. Conclusion HFNC oxygen therapy can replace NIV for sequential treatment of AHF patients after extubation from IMV.