High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure
Jean-Pierre Frat, Arnaud W Thille, Alain Mercat, Christophe Girault, Stéphanie Ragot, Sébastien Perbet, Gwénael Prat, Thierry Boulain, Elise Morawiec, Alice Cottereau, Jérôme Devaquet, Saad Nseir, Keyvan Razazi, Jean-Paul Mira, Laurent Argaud, Jean-Charles Chakarian, Jean-Damien Ricard, Xavier Wittebole, Stéphanie Chevalier, Alexandre Herbland, Muriel Fartoukh, Jean-Michel Constantin, Jean-Marie Tonnelier, Marc Pierrot, Armelle Mathonnet, Gaëtan Béduneau, Céline Delétage-Métreau, Jean-Christophe M Richard, Laurent Brochard, René Robert, FLORALI Study Group, REVA Network, Delphine Chatellier, Rémi Coudroy, Sandrine Thibault, Dominique Morand, Anne Renault, Nicolas Bizien, Pierre Asfar, Achille Kouatchet, Dalila Benzekri, Anne Bretagnol, Dorothée Carpentier, Fabienne Tamion, Alexandre Demoule, Alexandre Duguet, Jean Reignier, Jean-Baptiste Lascarrou, Alexis Soummer, Antony Lanceleur, Benoit Voisin, Emmanuelle Jaillette, Christian Brun-Buisson, Armand Mekontso-Dessap, Julien Charpentier, Guillaume Gery, Romain Hernu, Martin Cour, Pascal Beuret, Mahmoud Kaaki, Romain Miguel Montanes, Stéphane Gaudry, Laurent Fontaine, Emilie Bialais, Jean-Paul Gouello, Olivier Lesieur, Jonathan Messika, Marie Conrad, Claude Guerin, Sophie Marque, Eric Danin, Jean-Pierre Frat, Arnaud W Thille, Alain Mercat, Christophe Girault, Stéphanie Ragot, Sébastien Perbet, Gwénael Prat, Thierry Boulain, Elise Morawiec, Alice Cottereau, Jérôme Devaquet, Saad Nseir, Keyvan Razazi, Jean-Paul Mira, Laurent Argaud, Jean-Charles Chakarian, Jean-Damien Ricard, Xavier Wittebole, Stéphanie Chevalier, Alexandre Herbland, Muriel Fartoukh, Jean-Michel Constantin, Jean-Marie Tonnelier, Marc Pierrot, Armelle Mathonnet, Gaëtan Béduneau, Céline Delétage-Métreau, Jean-Christophe M Richard, Laurent Brochard, René Robert, FLORALI Study Group, REVA Network, Delphine Chatellier, Rémi Coudroy, Sandrine Thibault, Dominique Morand, Anne Renault, Nicolas Bizien, Pierre Asfar, Achille Kouatchet, Dalila Benzekri, Anne Bretagnol, Dorothée Carpentier, Fabienne Tamion, Alexandre Demoule, Alexandre Duguet, Jean Reignier, Jean-Baptiste Lascarrou, Alexis Soummer, Antony Lanceleur, Benoit Voisin, Emmanuelle Jaillette, Christian Brun-Buisson, Armand Mekontso-Dessap, Julien Charpentier, Guillaume Gery, Romain Hernu, Martin Cour, Pascal Beuret, Mahmoud Kaaki, Romain Miguel Montanes, Stéphane Gaudry, Laurent Fontaine, Emilie Bialais, Jean-Paul Gouello, Olivier Lesieur, Jonathan Messika, Marie Conrad, Claude Guerin, Sophie Marque, Eric Danin
Abstract
Background: Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.
Methods: We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28.
Results: A total of 310 patients were included in the analyses. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P=0.18 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24±8 days, vs. 22±10 in the standard-oxygen group and 19±12 in the noninvasive-ventilation group; P=0.02 for all comparisons). The hazard ratio for death at 90 days was 2.01 (95% confidence interval [CI], 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P=0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P=0.006).
Conclusions: In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health; FLORALI ClinicalTrials.gov number, NCT01320384.).
Source: PubMed