None listed
Conditions
Brief summary
The Humidified High-Flow Oxygen Therapy in the Emergency Room (HOTER) study aims to determine whether using humidified high flow nasal oxygen compared with standard oxygen therapy, for adult patients who present with breathing difficulty to the Emergency Department is associated with improved outcomes for those patients. The outcomes we are interested in are the need for advanced breathing support (non-invasive positive pressure ventilation (NIPPV)/invasive positive pressure ventilation (IPPV)); hospital length of stay (LOS), Emergency Department LOS, improvement in vital signs, survival to hospital discharge and patient experience.
Interventions
Nasal High Flow Oxygen is a technology whereby heated humidified oxygen is delivered via large bore nasal cannulae, enabling high flows of up to 50 L min-1 and a fraction of inspired oxygen (FiO2) which can be titrated from 21% to near 100%. These systems improve oxygenation through various mechanisms including washout of nasopharyngeal dead space, improved work of breathing through attenuation of inspiratory resistance, improved pulmonary compliance and provision of positive pressure. Heating a
Nasal High Flow Oxygen is a technology whereby heated humidified oxygen is delivered via large bore nasal cannulae, enabling high flows of up to 50 L min-1 and a fraction of inspired oxygen (FiO2) which can be titrated from 21% to near 100%. These systems improve oxygenation through various mechanisms including washout of nasopharyngeal dead space, improved work of breathing through attenuation of inspiratory resistance, improved pulmonary compliance and provision of positive pressure. Heating and humidification of oxygen prevents mucosal dehydration, maintains ciliary activity, reduces heat loss and may minimise atelectasis and tracheitis. Patients will be assessed for the presence of respiratory distress on arrival in the Emergency Department and if randomised to humidified high flow nasal Oxygen, receive 40L/min Oxygen for the duration of their Emergency Department stay. Once they leave the ED they will revert to standard Oxygen therapy at the discretion of the treating clinician
Sponsors
Dr Peter Jones
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
15 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
1. Adult patient (15 years or older) presenting to the Auckland City Hospital Emergency Department (AED). 2. Oxygenation impairment or respiratory distress as a presenting feature (defined as transcutaneous oxygen saturations measured at less than or equal to 92% on air (or less than or equal to 90% in the setting of chronic hypercapnia) AND respiratory rate greater than or equal to 22 breaths per minute at any time enroute to hospital or on arrival). 3. Oxygen therapy indicated in the opinion of the treating clinician.
Exclusion criteria
Intubated / NIPPV on arrival to or immediately in AED Bullous lung disease Pneumothorax Anatomical abnormality or malformation of the face Suspected facial or intracranial trauma Recent episode of epistaxis (less than 2 weeks) Recent facial surgery (less than 6 weeks) Prior history of trans-nasal neurosurgery Prior decision that the patient is for palliative care only
Outcome results
None listed