Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial.
Adult
Humans
Oxygen
/ therapeutic use
Noninvasive Ventilation
/ adverse effects
Hemothorax
/ complications
Thoracic Injuries
/ complications
Wounds, Nonpenetrating
/ complications
Oxygen Inhalation Therapy
/ adverse effects
Respiratory Insufficiency
/ therapy
Respiratory Distress Syndrome
/ therapy
Intubation, Intratracheal
/ adverse effects
Cannula
/ adverse effects
Chest trauma
High-flow nasal oxygen therapy
Intensive care
Non-invasive ventilation
Respiratory failure
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
26 04 2023
26 04 2023
Historique:
received:
10
01
2023
accepted:
04
04
2023
medline:
28
4
2023
pubmed:
27
4
2023
entrez:
26
4
2023
Statut:
epublish
Résumé
The benefit-risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20-2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73-5.89], p = 0.18, 0.85 [95%IC: 0.33-2.20], p = 0.74 and 2.14 [95%IC: 0.36-20.77], p = 0.41, respectively). A prompt association of HFNC-O NCT03943914, Registered 7 May 2019.
Sections du résumé
BACKGROUND
The benefit-risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O
METHODS
The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO
RESULTS
Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20-2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73-5.89], p = 0.18, 0.85 [95%IC: 0.33-2.20], p = 0.74 and 2.14 [95%IC: 0.36-20.77], p = 0.41, respectively).
CONCLUSION
A prompt association of HFNC-O
CLINICAL TRIAL REGISTRATION
NCT03943914, Registered 7 May 2019.
Identifiants
pubmed: 37101272
doi: 10.1186/s13054-023-04429-2
pii: 10.1186/s13054-023-04429-2
pmc: PMC10131545
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
163Informations de copyright
© 2023. The Author(s).
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