Journal Article

High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure

Frat, J. P, Group, Florali Study, Morawiec, E, Herbland, A, Ragot, S, Thille, A. W, Pierrot, M, Perbet, S, Fartoukh, M, Mira, J. P, Prat, G, Ricard, J. D, Constantin, J. M, Mercat, A, Chakarian, J. C, Mathonnet, A, Girault, C, Brochard, L, Chevalier, S, Nseir, S, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN) ; Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon) ; Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Richard, J. C, Argaud, Laurent, Razazi, K, Wittebole, X, Network, Reva, Tonnelier, J. M, Devaquet, J, Boulain, T, Cottereau, A, Robert, R, Deletage-Metreau, C, Beduneau, G

2015

Overview

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 Interregional 2010 of the French Ministry of Health; FLORALI ClinicalTrials.gov number, NCT01320384.).

• Publisher: Massachusetts Medical Society,CCSD
• Subject: Acute Disease / Adult / Aged / Blood pressure / Female / Humans / Hypercapnia / Hypoxemia / Hypoxia - etiology / Intubation / Intubation, Intratracheal - statistics & numerical data / Kaplan-Meier Estimate / Life Sciences / Male / Mechanical ventilation / Middle Aged / Mortality / Nose / Oxygen / Oxygen - administration & dosage / Oxygen Inhalation Therapy - instrumentation / Oxygen Inhalation Therapy - methods / Oxygen therapy / Patients / Positive-Pressure Respiration - instrumentation / Respiratory failure / Respiratory Insufficiency - complications / Respiratory Insufficiency - mortality / Respiratory Insufficiency - therapy / Respiratory therapy / Ventilation