Benefits of High Flow Nasal Cannula Oxygen for Preoxygenation During Intubation in Non Severely Hypoxemic Patients

Nantes University Hospital192 enrolled

Overview

The aim of this study is to determine whether High Flow nasal cannula (HFNC) oxygen is more efficient than the standard High Flow face mask (HFFM) for preoxygenation before orotracheal intubation after crash induction in non severely hypoxemic patients

This study will be designed as followed : patients will be randomized in 2 groups : High Flow nasal cannula "HFNC" or standard High Flow face mask "HFFM". Patients randomized in "HFNC" group will receive a four minutes preoxygenation period with Nasal High Flow Therapy (60 L/mn , fraction of inspired oxygen (FI02) = 100%) before orotracheal intubation under laryngoscopy after crash induction. After induction and during laryngoscopy, HFNC will be maintained in an attempt to achieve apneic oxygenation. Patients randomized in "HFFM" group will received a four minutes preoxygenation period with standard face mask (15 L/mn) before orotracheal intubation under laryngoscopy after crash induction. After induction, HFFM will be removed, enabling laryngoscopic vision

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

192

Conditions

Need for Intubation, No Severe Hypoxemia

Interventions

OPTIFLOW/ AIRVODEVICE

Patients randomized in "HFNC" group will received a four minutes preoxygenation period with Nasal High Flow Therapy (HFT) Optiflow ®/AIRVO® (60 l/mn FIO2 = 1) before orotracheal intubation under laryngoscopy after crash induction.

STANDARD Face MaskPROCEDURE

Patients randomized in "STANDARD Face Mask" group will received a four minutes preoxygenation period with a standard face mask (15 l/mn) before orotracheal intubation under laryngoscopy after crash induction.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults older than 18 years regardless of the gender * Requiring orotracheal intubation in intensive care unit * "No severely hypoxemic respiratory failure" defined as Oxygen Pression (Pa02)/FI02 \> 200 mmHg measured in the 4 hours before inclusion Exclusion Criteria: * Not the first Intubation during this stay in intensive care unit * Contraindication to oro-tracheal intubation * Intubation without anaesthesic rapid sequence induction * Intubation during cardiac arrest * Real emergency (as asphyxia) with immediate intubation needed (without time enough for randomization) * Nasopharyngeal obstacle with contraindication to use Optiflow device * Patients with a documented Cormack IV exposition before inclusion * Protected adult * Pregnancy or breastfeeding * Lack of consent * Patient already enrolled in another study that could interfere with the primary objective of this study

Locations (8)

Brest hospital, CHU La cavale Blanche, medical intensive care unit

Brest, France

CHD LES OUDOUAIRIES Service de réanimation polyvalente

La Roche-sur-Yon, France

Ch Le Mans

Le Mans, France

Outcomes

Primary Outcomes

lowest pulse oxymetry (SpO2) during intubation

This outcome will be assessed from the beginning of the endotracheal intubation procedure (immediately after induction) to the end of orotracheal intubation (airway catheterization) by monitoring the pulse oxymetry

Time frame: From the beginning of the endotracheal intubation procedure (beginning of laryngoscopy, immediately after induction) to completed orotracheal intubation (airway catheterization). Usual duration is inferior to 10 minutes

Secondary Outcomes

Pulse oximetry

Time frame: from the beginning of preoxygenation period to the end of intubation procedure. Usual duration is inferior to 15 minutes

number of desaturation events (under 80%)

Reduction in morbi-mortality during the Intensive care Unit stay

Time frame: from beginning of the preoxygenation period to discharged from intensive care unit (until day 28 for more)

SOFA score

Time frame: Each day during the 5 first days after randomisation

Data from ClinicalTrials.gov

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