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

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

Edité par CCSD ; Massachusetts Medical Society -

International audience. 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.).

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