Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL.

Abstract

INTRODUCTION:

A palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient's quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.

METHODS AND ANALYSIS:

This is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.

ETHICS AND DISSEMINATION:

The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER:

NCT03673631.

• Authors: René Robert, Denis Frasca, Julie Badin, C Girault, Christophe Guitton, Michel Djibre, Pascal Beuret, Jean Reignier, Dalila Benzekri-Llefevre, Suela Demiri, Hassène Rahmani, Laurent Argaud Argaud, Erwan I'her, Stephan Ehrmann, Olivier Lesieur, Khaldoune Kuteifan, Francois Thouy, Laura Federici, Didier Thevenin, Damien Contou, Nicolas Terzi, Saad Nseir, Martial Thyrault, Christophe Vinsonneau, Juliette Audibert, Juliette Masse, Alexandre Boyer, Bertrand Guidet, Riad Chelha, Jean-Pierre Quenot, G Piton, Nadia Aissaoui, Arnaud W Thille, Jean-Pierre Frat
• Journal: BMJ open (BMJ Open) Vol. 11 Issue 2 Pg. e045659 (02 12 2021) ISSN: 2044-6055 [Electronic] England
• PMID: 33579774 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Oxygen

Topics

• Humans
• Intensive Care Units
• Noninvasive Ventilation
• Oxygen
• Oxygen Inhalation Therapy
• Prospective Studies
• Quality of Life
• Respiratory Insufficiency (therapy)