High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure.
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Frat Jean-Pierre, Quenot Jean-Pierre, Guitton Christophe, Coudroy Rémi, Gacouin Arnaud, Badie Julio, Demoule Alexandre, Contou Damien, Carteaux Guillaume, Ehrmann Stephan, Jarousseau Fabien, Sedillot Nicholas, Rigaud Jean-Philippe, Reignier Jean, Beloncle François, Dureau Anne-Florence, Ferré Alexis, Daubin Cédric, Bourreau Anna, Delbove Agathe, Pradel Gaël, Fatah Abdelhamid, Colin Gwenhael, Deniel Guillaume, Lamouret Olivier, La Combe Béatrice, Prat Gwénaël, Galerneau Louis-Marie, Bourdin Gaël, Julien Gautier, Curtiaud Anaïs, Saint-Léger Mélanie, Turbil Emanuele, Reynaud Faustine, Chamblet Louis, Ragot Stéphanie, Thille Arnaud W, SOHO Trial Group and the REVA Network
Аннотация
METHODS: In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28.
RESULTS: A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group.
CONCLUSIONS: Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).