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Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

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Robert, R. | Frasca, D. | Badin, J. | Girault, C. | Guitton, C. | Djibre, M. | Beuret, P. | Reignier, J. | Benzekri-Llefevre, D. | Demiri, S. | Rahmani, H. | Argaud, L. A. | I'Her, E. | Ehrmann, S. | Lesieur, O. | Kuteifan, K. | Thouy, F. | Federici, L. | Thevenin, D. | Contou, D. | Terzi, N. | Nseir, S. | Thyrault, M. | Vinsonneau, C. | Audibert, J. | Masse, J. | Boyer, A. | Guidet, B. | Chelha, R. | Quenot, J. P. | Piton, G. | Aissaoui, N. | Thille, A. W. | Frat, J. P.

Edité par CCSD ; BMJ Publishing Group -

International audience. INTRODUCTION: A palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient's quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders. METHODS AND ANALYSIS: This is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03673631.

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