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

Frat, J-Pierre.; Thille, A.W.; Mercat, A.; Girault, C.; Ragot, Séphanie.; Perbet, Sébastien.; Prat, Génael.; Boulain, T.; Morawiec, E.; Cottereau, A.; Devaquet, Jérôme.; Nseir, S.; Razazi, K.; Mira, J-Paul.; Argaud, L.; Chakarian, J-Charles.; Ricard, J-Damien.; Wittebole, X.; Chevalier, Séphanie.; Herbland, A.; Fartoukh, M.; Constantin, J-Michel.; Tonnelier, J-Marie.; Pierrot, M.; Mathonnet, A.; Béduneau, Gëtan.; Delétage-Métreau, Céline.; Richard, J-Christophe.M.; Brochard, L.; Rober

New England Journal of Medicine 372(23): 2185-2196

2015


ISSN/ISBN: 0028-4793
PMID: 25981908
DOI: 10.1056/nejmoa1503326
Accession: 057993841

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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. 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. 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). 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.).

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