SciCombinator

Discover the most talked about and latest scientific content & concepts.

High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure

OPEN The New England journal of medicine | 20 May 2015

JP Frat, AW Thille, A Mercat, C Girault, S Ragot, S Perbet, G Prat, T Boulain, E Morawiec, A Cottereau, J Devaquet, S Nseir, K Razazi, JP Mira, L Argaud, JC Chakarian, JD Ricard, X Wittebole, S Chevalier, A Herbland, M Fartoukh, JM Constantin, JM Tonnelier, M Pierrot, A Mathonnet, G Béduneau, C Delétage-Métreau, JC Richard, L Brochard and R Robert
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 .).
Tweets*
297
Facebook likes*
32
Reddit*
0
News coverage*
25
Blogs*
13
SC clicks
0
Concepts
Partial pressure, Breathing gas, Oxygen therapy, Hypoxemia, Hypoxia, Nasal cannula, Intensive care medicine, Oxygen
MeSH headings
-
comments powered by Disqus

* Data courtesy of Altmetric.com