Acute Respiratory Failure With Hypoxia
Conditions
Keywords
alveolar recruitment, electrical impedance tomography, non-invasive ventilation, high-flow nasal cannula oxygen therapy, hypoxemic acute respiratory failure
Brief summary
This physiological study showed an increase in regional ventilation with NIV but no difference in alveolar recruitment as compared to HFNC in patients with hypoxemic ARF. Although NIV provided better oxygenation than HFNC, the effect on lung volumes could explain the potentially deleterious effect of NIV in hypoxemic ARF, reinforcing the recently developed concept of patient self-inflicted lung injury.
Detailed description
Background: High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).
Interventions
DEVICEnon invasive ventilation and high flow nasal canulae oxygen therapy
patients with hypoxemic acute respiratory failure received alternatively non invasive ventilation and high flow nasal canulae oxygen therapy
Sponsors
University Hospital, Rouen
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients referred in ICU * with hypoxemic acute respiratory failure due to a community acquired pneumonia confirmed by chest X ray, * with PaO2 \< 60mmHg in ambient air, without hypercapnia (PaCO2 \< 45 mmHg), * requiring more than 6L/min of O2 on admission with high concentration FM, and justifying HFNC or NIV for the attending ICU physician
Exclusion criteria
* cardiogenic pulmonary oedema, * moderate to severe underlying respiratory disease including COPD (chronic obstructive pulmonary disease) * contraindication to or failure of previous NIV or HFNC with the need for immediate invasive ventilation * pregnant or breast-feeding women * carrier of an implantable defibrillator or pacemaker * body mass index (BMI)\>50 kg/m2 * with cutaneous lesion next to the positioning zone of the Pulmovista® (Dräger, Lübeck, Germany) belt
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| global EELI | after 5 minutes of stable breathing with the oxygenation technic | measurement of global end respiratory lung impedance with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ROI EELI | after 5 minutes of stable breathing with the oxygenation technic | measurement of regional of interest (ROI) end respiratory lung impedance with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit |
| global TV | after 5 minutes of stable breathing with the oxygenation technic | measurement of global tidal variation (TV) with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit |
| ROI TV | after 5 minutes of stable breathing with the oxygenation technic | measurement of regional tidal variation with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit |
Countries
France
Contacts
STUDY_DIRECTORChristophe GIRAULT, MD
Medical Intensive Care Department, Rouen University Hospital, F-76000 Rouen, France
Outcome results
None listed