Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial.

Acute Disease Catheterization Female Humans Hypoxia / etiology Intubation, Intratracheal Male Middle Aged Noninvasive Ventilation / methods Nose Oximetry Oxygen Inhalation Therapy / methods Respiration, Artificial / methods Respiratory Insufficiency / therapy

Journal

The Lancet. Respiratory medicine

ISSN: 2213-2619

Titre abrégé: Lancet Respir Med

Pays: England

ID NLM: 101605555

Informations de publication

Date de publication:
04 2019

Historique:

received: 31 10 2018

revised: 14 12 2018

accepted: 19 12 2018

pubmed: 23 3 2019

medline: 18 4 2020

entrez: 23 3 2019

Statut: ppublish

Résumé

Non-invasive ventilation has never been compared with high-flow oxygen to determine whether it reduces the risk of severe hypoxaemia during intubation. We aimed to determine if preoxygenation with non-invasive ventilation was more efficient than high-flow oxygen in reducing the risk of severe hypoxaemia during intubation. The FLORALI-2 multicentre, open-label trial was done in 28 intensive care units in France. Adult patients undergoing tracheal intubation for acute hypoxaemic respiratory failure (a partial pressure of arterial oxygen [PaO Between April 15, 2016, and Jan 8, 2017, 2079 patients were intubated in the 28 participating units, and 322 were enrolled. We excluded five patients with no recorded data, two who withdrew consent or were under legal protection, one who was not intubated, and one who had a cardiac arrest. Of the 313 patients included in the intention-to-treat analysis, 142 were assigned to non-invasive ventilation and 171 to high-flow oxygen therapy. Severe hypoxaemia occurred in 33 (23%) of 142 patients after preoxygenation with non-invasive ventilation and 47 (27%) of 171 with high-flow oxygen (absolute difference -4·2%, 95% CI -13·7 to 5·5; p=0·39). In the 242 patients with moderate-to-severe hypoxaemia (PaO In patients with acute hypoxaemic respiratory failure, preoxygenation with non-invasive ventilation or high-flow oxygen therapy did not change the risk of severe hypoxaemia. Future research should explore the effect of preoxygenation method in patients with moderate-to-severe hypoxaemia at baseline. French Ministry of Health.

Sections du résumé

BACKGROUND

METHODS

The FLORALI-2 multicentre, open-label trial was done in 28 intensive care units in France. Adult patients undergoing tracheal intubation for acute hypoxaemic respiratory failure (a partial pressure of arterial oxygen [PaO

FINDINGS

Between April 15, 2016, and Jan 8, 2017, 2079 patients were intubated in the 28 participating units, and 322 were enrolled. We excluded five patients with no recorded data, two who withdrew consent or were under legal protection, one who was not intubated, and one who had a cardiac arrest. Of the 313 patients included in the intention-to-treat analysis, 142 were assigned to non-invasive ventilation and 171 to high-flow oxygen therapy. Severe hypoxaemia occurred in 33 (23%) of 142 patients after preoxygenation with non-invasive ventilation and 47 (27%) of 171 with high-flow oxygen (absolute difference -4·2%, 95% CI -13·7 to 5·5; p=0·39). In the 242 patients with moderate-to-severe hypoxaemia (PaO

INTERPRETATION

In patients with acute hypoxaemic respiratory failure, preoxygenation with non-invasive ventilation or high-flow oxygen therapy did not change the risk of severe hypoxaemia. Future research should explore the effect of preoxygenation method in patients with moderate-to-severe hypoxaemia at baseline.

FUNDING

French Ministry of Health.

Identifiants

DOI: 10.1016/S2213-2600(19)30048-7 PMID: 30898520

pubmed: 30898520

pii: S2213-2600(19)30048-7

doi: 10.1016/S2213-2600(19)30048-7

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT02668458']

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

303-312

Investigateurs

Delphine Chatellier (D)

Florence Boissier (F)

Anne Veinstein (A)

René Robert (R)

Céline Deletage-Métreau (C)

Morgane Olivry (M)

Claire Dahyot-Fizelier (C)

Auguste Dargent (A)

Audrey Large (A)

Emmanuelle Begot (E)

Claire Mancia (C)

Maxence Decavele (M)

Martin Dres (M)

Samuel Lehingue (S)

Laurent Papazian (L)

Marine Paul (M)

Nathalie Marin (N)

Matthieu Le Meur (M)

Mohammed Laissy (M)

Anaita Rouzé (A)

Saad Nseir (S)

Matthieu Henry-Lagarrigue (M)

Aihem Yehia (A)

Frédéric Martino (F)

Charles Cerf (C)

Pierre Bailly (P)

Julie Helms (J)

Jean Baptiste Putegnat (JB)

Armand Mekontso-Dessap (A)

Thierry Boulain (T)

Pierre Asfar (P)

Séverin Cabasson (S)

Florent Wallet (F)

Kada Klouche (K)

Frédéric Bellec (F)