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

J. P. Frat , A. W. Thille , A. Mercat , C. Girault , S. Ragot , S. Perbet , G. Prat , T. Boulain , E. Morawiec , A. Cottereau , J. Devaquet , S. Nseir , K. Razazi , J. P. Mira , Laurent Argaud (1) , J. C. Chakarian , J. D. Ricard , X. Wittebole , S. Chevalier , A. Herbland , M. Fartoukh , J. M. Constantin , J. M. Tonnelier , M. Pierrot , A. Mathonnet , G. Beduneau , C. Deletage-Metreau , J. C. Richard , L. Brochard , R. Robert , Florali Study Group , Reva Network

1 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition

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.).

Mots clés: Adult; Female; Humans; Male; Aged; Middle Aged; Kaplan-Meier Estimate; Acute Disease; Anoxia/etiology; Intubation; Intratracheal/statistics & numerical data; Oxygen Inhalation Therapy/instrumentation/*methods; Oxygen/*administration & dosage; Positive-Pressure Respiration/*instrumentation; Respiratory Insufficiency/complications/mortality/*therapy

Domaines: Sciences du Vivant [q-bio]

J. P. Frat, A. W. Thille, A. Mercat, C. Girault, S. Ragot, et al.. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. New England Journal of Medicine, 2015, 372 (23), pp.2185-96. ⟨10.1056/NEJMoa1503326⟩. ⟨hal-01850556⟩