Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial

Jaber, Samir; Monnin, Marion; Girard, Mehdi; Conseil, Matthieu; Cissé, Moussa; Carr, Julie; Mahul, Martin; Delay, J; Belafia, Fouad; Chanques, Gérald; Molinari, Nicolas; Jong, Audrey De

doi:10.1007/s00134-016-4588-9

Cited by 207 publications

(148 citation statements)

References 34 publications

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“…The median SpO 2 was significantly lower and the prevalence of severe hypoxaemia (SpO 2 <80%) was present exclusively in the face mask group. Similar results were observed in a recent study, comparing the combination of NHF and NIV versus NIV alone, during the intubation procedure in patients with severe hypoxaemic respiratory failure [60]. Even without lung expansion, oxygen diffusion from the alveoli to the capillaries decreases alveolar pressure, and by increasing pharyngeal oxygen content a flow of air is generated from the pharynx to the distal airway, which is called apnoeic oxygenation [61].…”

Section: No Benefitsupporting

confidence: 82%

“…FiO 2 values administered via NHF are more stable and higher than those of standard oxygen delivery systems [1], because NHF can generate high flow rates up to 60 L·min −1 that can match or even exceed the patient's inspiratory flow demand, thus reducing entrainment of room air and dilution of administered oxygen [3,4]. In addition, these high flow rates create a positive airway pressure which linearly correlates with the administered flow rate [3][4][5][6][7][8].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

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Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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Section: No Benefitsupporting

confidence: 82%

Section: Mechanisms Of Actionmentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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“…Until recently, the combined use of NIV and HFNC for preoxygenation had never been evaluated. In a proof-ofconcept study [11], preoxygenation incorporating both NIV and HFNC (OPTINIV), respectively-thereby combining the concepts of prevention of alveolar derecruitment and of apnoeic oxygenation-was found to be more effective in reducing oxygen desaturation than the reference method of NIV alone.…”

Section: When Intubation Is Needed: Optimize Preoxygenation!mentioning

confidence: 99%

“…The main challenge remains avoiding a delay in intubation, which is associated with increased mortality [9]. (2) Preoxygenation: a new preoxygenation strategy was recently reported, which features the coupling of NIV and HFNC (OPTINIV) to reduce respiratory complications of intubation [11]. It was found to be more effective in reducing oxygen desaturation in severely hypoxemic patients than the reference method of NIV alone [11].…”

Section: New Parameters For Monitoring Invasive Mechanical Ventilationmentioning

confidence: 99%

“…(2) Preoxygenation: a new preoxygenation strategy was recently reported, which features the coupling of NIV and HFNC (OPTINIV) to reduce respiratory complications of intubation [11]. It was found to be more effective in reducing oxygen desaturation in severely hypoxemic patients than the reference method of NIV alone [11]. (3) Invasive mechanical ventilation: new studies have suggested that high driving pressure (above 13 cmH 2 O) is associated with increased mortality in ARDS [1,12].…”

Section: New Parameters For Monitoring Invasive Mechanical Ventilationmentioning

confidence: 99%

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Focus on ventilation and airway management in the ICU

2017

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Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure

Azoulay

Lemiale

Mokart

et al. 2018

JAMA

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242

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IMPORTANCE High-flow nasal oxygen therapy is increasingly used for acute hypoxemic respiratory failure (AHRF). OBJECTIVE To determine whether high-flow oxygen therapy decreases mortality among immunocompromised patients with AHRF compared with standard oxygen therapy. DESIGN, SETTING, AND PARTICIPANTS The HIGH randomized clinical trial enrolled 776 adult immunocompromised patients with AHRF (PaO 2 <60 mm Hg or SpO 2 <90% on room air, or tachypnea >30/min or labored breathing or respiratory distress, and need for oxygen Ն6 L/min) at 32 intensive care units (ICUs) in France between May 19, 2016, and December 31, 2017. INTERVENTIONS Patients were randomized 1:1 to continuous high-flow oxygen therapy (n = 388) or to standard oxygen therapy (n = 388). MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality. Secondary outcomes included intubation and mechanical ventilation by day 28, PaO 2 :FIO 2 ratio over the 3 days after intubation, respiratory rate, ICU and hospital lengths of stay, ICU-acquired infections, and patient comfort and dyspnea. RESULTS Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial. At randomization, median respiratory rate was 33/min (IQR, 28-39) vs 32 (IQR, 27-38) and PaO 2 :FIO 2 was 136 (IQR, 96-187) vs 128 (IQR, 92-164) in the intervention and control groups, respectively. Median SOFA score was 6 (IQR, 4-8) in both groups. Mortality on day 28 was not significantly different between groups (35.6% vs 36.1%; difference, −0.5% [95% CI, −7.3% to +6.3%]; hazard ratio, 0.98 [95% CI, 0.77 to 1.24]; P = .94). Intubation rate was not significantly different between groups (38.7% vs 43.8%; difference, −5.1% [95% CI, −12.3% to +2.0%]). Compared with controls, patients randomized to high-flow oxygen therapy had a higher PaO 2 :FIO 2 (150 vs 119; difference, 19.5 [95% CI, 4.4 to 34.6]) and lower respiratory rate after 6 hours (25/min vs 26/min; difference, −1.8/min [95% CI, −3.2 to −0.2]). No significant difference was observed in ICU length of stay (8 vs 6 days; difference, 0.6 [95% CI, −1.0 to +2.2]), ICU-acquired infections (10.0% vs 10.6%; difference, −0.6% [95% CI, −4.6 to +4.1]), hospital length of stay (24 vs 27 days; difference, −2 days [95% CI, −7.3 to +3.3]), or patient comfort and dyspnea scores. CONCLUSIONS AND RELEVANCE Among critically ill immunocompromised patients with acute respiratory failure, high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02739451.

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Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial

Abstract: A novel strategy for preoxygenation in hypoxaemic patients, adding HFNC for apnoeic oxygenation to NIV prior to orotracheal intubation, may be more effective in reducing the severity of oxygen desaturation than the reference method using NIV alone.

Cited by 207 publications

References 34 publications

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Focus on ventilation and airway management in the ICU

Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure

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