High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure
Jean-Pierre Frat, J. Quenot, Christophe Guitton, Rémi Coudroy, Arnaud Gacouin, Julio Badie, Alexandre Demoule, Damien Contou, Guillaume Carteaux, Stephan Ehrmann, Fabien Jarousseau, Nicholas Sédillot, J. Rigaud, Jean Reignier, François Beloncle, Anne‐Florence Dureau, Alexis Ferré, Cédric Daubin, Anna Bourreau, Agathe Delbove, G Pradel, Abdelhamid Fatah, Gwenhael Colin, Guillaume Deniel, Olivier Lamouret, Béatrice La Combe, Gwenael Prat, Louis-Marie Galerneau, Gaël Bourdin, Gautier Julien, Anaïs Curtiaud, Mélanie Saint-Léger, Emanuele Turbil, Faustine Reynaud, Louis Chamblet, Stéphanie Ragot, A. W. Thille
Abstract
BACKGROUND: Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. 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.).