Jean-Pierre Frat1,2,3, Stéphanie Ragot4,5,3, Rémi Coudroy1,2,3, Jean-Michel Constantin6,7, Christophe Girault8, Gwénael Prat9, Thierry Boulain10, Alexandre Demoule11,12, Jean-Damien Ricard13,14,15, Keyvan Razazi16, Jean-Baptiste Lascarrou17, Jérôme Devaquet18, Jean-Paul Mira19, Laurent Argaud20, Jean-Charles Chakarian21, Muriel Fartoukh22, Saad Nseir23, Alain Mercat24, Laurent Brochard25,26, René Robert1,2,3, Arnaud W Thille1,2,3. 1. CHU de Poitiers, Réanimation Médicale, Poitiers, France. 2. INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France. 3. Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France. 4. INSERM, CIC-1402, Biostatistics, Poitiers, France. 5. CIC-1402, Poitiers, France. 6. CHU Clermont-Ferrand, Pôle de Médecine Périopératoire, Clermont-Ferrand, France. 7. R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France. 8. Department of Medical Intensive Care, Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen University Hospital, Rouen, France. 9. CHU de la Cavale Blanche, Service de Réanimation Médicale, Brest, France. 10. Centre Hospitalier Régional d'Orléans, Réanimation médico-chirurgicale, Orléans, France. 11. Groupe Hospitalier Universitaire Pitié Salpêtrière, Service de Pneumologie et Réanimation Médicale, Paris, France. 12. Université Pierre et Marie Curie - Paris 6, Paris, France. 13. Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, F-92700, Colombes, France. 14. Université Paris Diderot, UMR IAME 1137, Sorbonne Paris Cité, F-75018, Paris, France. 15. INSERM, IAME 1137, F-75018, Paris, France. 16. AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010 France, GRC CARMAS, Créteil, France. 17. Centre Hospitalier Départemental de La Roche sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France. 18. Hôpital Foch, Réanimation Polyvalente, Suresnes, France. 19. Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Hôpital Cochin, Réanimation Médicale, and Université Paris Descartes, Paris, France. 20. Hospices Civils de Lyon, Groupement Hospitalier Universitaire Edouard Herriot, Service de Réanimation Médicale, Lyon, France. 21. Centre Hospitalier de Roanne, Réanimation Polyvalente, Roanne, France. 22. Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Réanimation, Paris, France. 23. CHU de Lille, Centre de Réanimation, Université de Lille, Faculté de Médecine, Lille, France. 24. CHU Angers, Département de Réanimation Médicale et Médecine Hyperbare, Angers, France. 25. Keenan Research Centre and Critical Care Department, St Michael's Hospital, Toronto, ON, Canada. 26. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVES: In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently needed in these patients with a risk of delay, and early predictors of failure may help clinicians to decide early. We aimed to identify factors associated with intubation in patients with acute hypoxemic respiratory failure treated with different noninvasive oxygenation techniques. DESIGN: Post hoc analysis of a randomized clinical trial. SETTING: Twenty-three ICUs. PATIENTS: Patients with a respiratory rate greater than 25 breaths/min and a PaO2/FIO2 ratio less than or equal to 300 mm Hg. INTERVENTION: Patients were treated with standard oxygen, high-flow nasal cannula oxygen, or noninvasive ventilation. MEASUREMENT AND MAIN RESULTS: Respiratory variables one hour after treatment initiation. Under standard oxygen, patients with a respiratory rate greater than or equal to 30 breaths/min were more likely to need intubation (odds ratio, 2.76; 95% CI, 1.13-6.75; p = 0.03). One hour after high-flow nasal cannula oxygen initiation, increased heart rate was the only factor associated with intubation. One hour after noninvasive ventilation initiation, a PaO2/FIO2 ratio less than or equal to 200 mm Hg and a tidal volume greater than 9 mL/kg of predicted body weight were independent predictors of intubation (adjusted odds ratio, 4.26; 95% CI, 1.62-11.16; p = 0.003 and adjusted odds ratio, 3.14; 95% CI, 1.22-8.06; p = 0.02, respectively). A tidal volume above 9 mL/kg during noninvasive ventilation remained independently associated with 90-day mortality. CONCLUSIONS: In patients with acute hypoxemic respiratory failure breathing spontaneously, the respiratory rate was a predictor of intubation under standard oxygen, but not under high-flow nasal cannula oxygen or noninvasive ventilation. A PaO2/FIO2 below 200 mm Hg and a high tidal volume greater than 9 mL/kg were the two strong predictors of intubation under noninvasive ventilation.
RCT Entities:
OBJECTIVES: In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently needed in these patients with a risk of delay, and early predictors of failure may help clinicians to decide early. We aimed to identify factors associated with intubation in patients with acute hypoxemic respiratory failure treated with different noninvasive oxygenation techniques. DESIGN: Post hoc analysis of a randomized clinical trial. SETTING: Twenty-three ICUs. PATIENTS: Patients with a respiratory rate greater than 25 breaths/min and a PaO2/FIO2 ratio less than or equal to 300 mm Hg. INTERVENTION: Patients were treated with standard oxygen, high-flow nasal cannula oxygen, or noninvasive ventilation. MEASUREMENT AND MAIN RESULTS: Respiratory variables one hour after treatment initiation. Under standard oxygen, patients with a respiratory rate greater than or equal to 30 breaths/min were more likely to need intubation (odds ratio, 2.76; 95% CI, 1.13-6.75; p = 0.03). One hour after high-flow nasal cannula oxygen initiation, increased heart rate was the only factor associated with intubation. One hour after noninvasive ventilation initiation, a PaO2/FIO2 ratio less than or equal to 200 mm Hg and a tidal volume greater than 9 mL/kg of predicted body weight were independent predictors of intubation (adjusted odds ratio, 4.26; 95% CI, 1.62-11.16; p = 0.003 and adjusted odds ratio, 3.14; 95% CI, 1.22-8.06; p = 0.02, respectively). A tidal volume above 9 mL/kg during noninvasive ventilation remained independently associated with 90-day mortality. CONCLUSIONS: In patients with acute hypoxemic respiratory failure breathing spontaneously, the respiratory rate was a predictor of intubation under standard oxygen, but not under high-flow nasal cannula oxygen or noninvasive ventilation. A PaO2/FIO2 below 200 mm Hg and a high tidal volume greater than 9 mL/kg were the two strong predictors of intubation under noninvasive ventilation.
Authors: Adam J Hayek; Vincent Scott; Peter Yau; Kiumars Zolfaghari; Matthew Goldwater; Julie Almquist; Alejandro C Arroliga; Shekhar Ghamande Journal: Proc (Bayl Univ Med Cent) Date: 2020-03-06
Authors: C Darreau; F Martino; M Saint-Martin; S Jacquier; J F Hamel; M A Nay; N Terzi; G Ledoux; F Roche-Campo; L Camous; F Pene; T Balzer; F Bagate; J Lorber; P Bouju; C Marois; R Robert; S Gaudry; M Commereuc; M Debarre; N Chudeau; P Labroca; K Merouani; P Y Egreteau; V Peigne; C Bornstain; E Lebas; F Benezit; S Vally; S Lasocki; A Robert; A Delbove; N Lerolle Journal: Ann Intensive Care Date: 2020-05-24 Impact factor: 6.925
Authors: Domenico Luca Grieco; Salvatore Maurizio Maggiore; Oriol Roca; Elena Spinelli; Bhakti K Patel; Arnaud W Thille; Carmen Sílvia V Barbas; Marina Garcia de Acilu; Salvatore Lucio Cutuli; Filippo Bongiovanni; Marcelo Amato; Jean-Pierre Frat; Tommaso Mauri; John P Kress; Jordi Mancebo; Massimo Antonelli Journal: Intensive Care Med Date: 2021-07-07 Impact factor: 17.440