Physiologic Effects of High Flow Nasal Therapy in Patients With Acute Hypoxemic Respiratory Failure (OPTIFLOW)

University Hospital, Bordeaux12 enrolled

Overview

The aim of the study is to assess, in patients with acute hypoxemic respiratory failure, the short term physiologic effects of the high flow oxygen nasal therapy (Optiflow), in term of inspiratory muscle effort, gas exchange, comfort and dyspnea

The administration of a known concentration of oxygen is an important part of routine care of the patient admitted in intensive care unit for acute hypoxemic respiratory failure. A new high flow oxygen delivery system (Fisher and Paykel Health care) has been developed (Optiflow). The system used a heated humidifier and heated breathing circuit via a nasal interface. High flow nasal therapy (Optiflow) is associated with the generation of significant positive airway pressure in healthy volunteers. Positive expiratory pressure may have a number of benefits in respiratory failure which include improved ventilation/perfusion matching with improved oxygenation, reduced airways resistance and reduced work of breathing. Moreover high flow nasal therapy may improve oxygen administration by decreasing oxygen dilution, decreasing death space and using high levels of humidification

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Respiratory Failure

Interventions

O2standPROCEDURE

Standard low flow oxygen therapy (O2stand). The patients will receive oxygen delivered through a face mask. The FiO2 will be adjusted in order to obtain a SaO2 \> 90%. The FiO2 will be determined by a portable oxygen analyzer (MiniOX I; Mine Safety Appliances Co, Pittsburgh, Pa)

CPAPPROCEDURE

o Continuous positive airway pressure (CPAP). CPAP will be set at 7.5 cmH2O. Airway humidification will be achieved by using a heated humidifier (MR640; Fisher \& Paykel, Auckland, NZ). The FiO2 will be adjusted in order to obtain a SaO2 \> 90%. A facial mask composed of a transparent mask and a soft inflatable will be used

OptiflowPROCEDURE

High flow oxygen nasal therapy (Optiflow). The flow will be set at 40l/min. The inspired fraction of oxygen (FiO2) will be adjusted in order to obtain a SaO2 \> 90%

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Acute respiratory insufficiency, defined as the PaO2/FIO2 ratio of 300 mm Hg or less after breathing oxygen * The presence of lung infiltrates on a posteroanterior chest radiograph Exclusion Criteria: * Face or cranial trauma or surgery * Patients younger than 18 years * History of COPD * Acute respiratory acidosis (defined as a pH \<7.30 and a PaCO2 \>50 mm Hg) * Hemodynamic instability with arterial pressure \< 90mmHg * Respiratory instability with PaO2/FiO2\<100mmHg * ventricular arrhythmias * Excess respiratory secretions. * Upper gastrointestinal bleeding * Recent gastric or oesophageal surgery * Tracheostomy or other airways disorders * Pneumothorax * Contraindication of gastric probe insertion * Impossibility to insert the oesophageal probe

Locations (1)

Pellegrin Hospital, Recovery Unit

Bordeaux, France

Outcomes

Primary Outcomes

Inspiratory muscle effort : oesophageal pressure (Poes) and the oesophageal pressure time product (PTPoes)

Time frame: Every 30 minutes for 90 minutes

Secondary Outcomes

Gas exchange :PaO2/FiO2 ratio

Time frame: Every 30 minutes for 90 minutes

Comfort assessed using a five-item semi quantitative scale

Time frame: Every 30 minutes for 90 minutes

Dyspnea assessed using a visual analogic scale

Time frame: Every 30 minutes for 90 minutes

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.