High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial
| Title: | High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial |
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| Authors: | Coudroy R.; Frat J. -P.; Ehrmann S.; Pene F.; Decavele M.; Terzi N.; Prat G.; Garret C.; Contou D.; Gacouin A.; Bourenne J.; Girault C.; Vinsonneau C.; Dellamonica J.; Labro G.; Jochmans S.; Herbland A.; Quenot J. -P.; Devaquet J.; Benzekri D.; Vivier E.; Nseir S.; Colin G.; Thevenin D.; Grasselli G.; Bougon D.; Assefi M.; Guerin C.; Lherm T.; Kouatchet A.; Ragot S.; Thille A. W.; Delphine C.; Anne V.; Florence B.; Faustine R.; Maeva R.; Florent J.; Francois A.; Victor D. R.; Rene R.; Laetitia B. -C.; Charlotte S. G.; Emmanuelle M.; Paul J.; Nathalie M.; Marine P.; Morgane F.; Suela D.; Alexandre D.; Clara C.; Anais D.; Florian S.; Vanessa J. M.; Raphael L. M.; Pierre B.; Amelie S.; Jean-Baptiste L.; Emmanuel C.; Gaetan P.; Radj C.; Joanna T.; Adel M.; Benoit P.; Julien C.; Marc G.; Gaetan B.; Dorothee C.; Dominique M.; Mehdi M.; Clement S.; Nicolas M.; Pauline S.; Quentin L.; Pascal A.; David C.; Mai Anh N. |
| Contributors: | R. Coudroy; J.-. Frat; S. Ehrmann; F. Pene; M. Decavele; N. Terzi; G. Prat; C. Garret; D. Contou; A. Gacouin; J. Bourenne; C. Girault; C. Vinsonneau; J. Dellamonica; G. Labro; S. Jochman; A. Herbland; J.-. Quenot; J. Devaquet; D. Benzekri; E. Vivier; S. Nseir; G. Colin; D. Thevenin; G. Grasselli; D. Bougon; M. Assefi; C. Guerin; T. Lherm; A. Kouatchet; S. Ragot; A.W. Thille; C. Delphine; V. Anne; B. Florence; R. Faustine; R. Maeva; J. Florent; A. Francoi; D.R. Victor; R. Rene; B.-. Laetitia; S.G. Charlotte; M. Emmanuelle; J. Paul; M. Nathalie; P. Marine; F. Morgane; D. Suela; D. Alexandre; C. Clara; D. Anai; S. Florian; J.M. Vanessa; L.M. Raphael; B. Pierre; S. Amelie; L. Jean-Baptiste; C. Emmanuel; P. Gaetan; C. Radj; T. Joanna; M. Adel; P. Benoit; C. Julien; G. Marc; B. Gaetan; C. Dorothee; M. Dominique; M. Mehdi; S. Clement; M. Nicola; S. Pauline; L. Quentin; A. Pascal; C. David; N. Mai Anh |
| Publisher Information: | Elsevier |
| Publication Year: | 2022 |
| Collection: | The University of Milan: Archivio Istituzionale della Ricerca (AIR) |
| Subject Terms: | Adult; Critical Illne; Human; Immunocompromised Host; Oxygen; Oxygen Inhalation Therapy; Noninvasive Ventilation; Respiratory Distress Syndrome; Respiratory Insufficiency; Settore MED/41 - Anestesiologia |
| Description: | Background: Although non-invasive ventilation (NIV) is recommended for immunocompromised patients with acute respiratory failure in the intensive care unit (ICU), it might have deleterious effects in the most severe patients. High-flow nasal oxygen (HFNO) alone might be an alternative method to reduce mortality. We aimed to determine whether HFNO alone could reduce the rate of mortality at day 28 compared with HFNO alternated with NIV. Methods: FLORALI-IM is a multicentre, open-label, randomised clinical trial conducted in 29 ICUs (28 in France and one in Italy). Adult immunocompromised patients with acute respiratory failure, defined as respiratory rate of 25 breaths per min or more and a partial pressure of arterial oxygen to inspired fraction of oxygen ratio of 300 mm Hg or lower, were randomly assigned (1:1) to HFNO alone (HFNO alone group) or NIV alternating with HFNO (NIV group). Key exclusion criteria were severe hypercapnia above 50 mm Hg, patients who could strongly benefit from NIV (ie, those with underlying chronic lung disease, with cardiogenic pulmonary oedema, or who were postoperative), severe shock, impaired consciousness defined as Glasgow coma score ≤12, urgent need for intubation, do not intubate order, and contraindication to NIV. Patients were assigned using computer-generated permuted blocks and were stratified according to centre and to the type of immunosuppression using a centralised web-based management system. In the HFNO alone group, patients were continuously treated by HFNO with a gas flow rate of 60 L/min or the highest tolerated. In the NIV group, patients were treated with NIV with a first session of at least 4 h, and then by sessions for a minimal duration of 12 h a day, with a dedicated ventilator, targeting a tidal volume below 8 mL/kg of predicted bodyweight, and with a positive end-expiratory level of at least 8 cm H2O. NIV sessions were interspaced with HFNO delivered as in the HFNO alone group. The primary outcome was mortality at day 28 and was assessed in the ... |
| Document Type: | article in journal/newspaper |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/35325620; info:eu-repo/semantics/altIdentifier/wos/WOS:000835334000011; volume:10; issue:7; firstpage:641; lastpage:649; numberofpages:9; journal:THE LANCET RESPIRATORY MEDICINE; https://hdl.handle.net/2434/945197 |
| DOI: | 10.1016/S2213-2600(22)00096-0 |
| Availability: | https://hdl.handle.net/2434/945197; https://doi.org/10.1016/S2213-2600(22)00096-0 |
| Rights: | info:eu-repo/semantics/closedAccess |
| Accession Number: | edsbas.BE87E69B |
| Database: | BASE |