Extubation stay at high risk of reintubation even scheduled and in the best condition of hematosis. Re-intubation's rate in main studies in chronic obstructive diseases reach to 20% and it is associated to a higher mortality, higher pneumonia under mechanic ventilation, and higher duration of hospitalization especially in intensive care units. Place of NIV in this situation is still on evaluation. A recent meta-analysis demonstrates that use of NIV in post-extubation in COPD seems to decrease re-intubation rate. HFO, thanks to its properties (oxygen, humidification and heat with high flow) could be useful in this population in ventilatory weaning. Compared to oxygen conventional therapy with high-concentration mask, HFO seems to be as efficient and better tolerated. A recent study shows that HFO is non-inferior to NVI in post-extubation in patient with high risk of re-intubation. Furthermore, oxygenation in post-extubation should be optimized to avoid hypoxemia and hypercapnia in this patient at risk of hypoventilation. Place of AFOT could improve hematosis by providing adapted flow of oxygen to each patient. The investigator choose the hypothesis for this study that HFO is as effective and tolerated in post-extubation than NIV with AFOT.
A recent meta-analysis demonstrates that use of NIV in post-extubation in obstructive chronic bronchopathies seems to decrease re-intubation rate. High Flow Oxygen, thanks to its properties (oxygen, humidification and heat with high flow) could be useful in this population in ventilatory weaning. Compared to oxygen conventional therapy with high-concentration mask, High Flow Oxygen seems to be as efficient and better tolerated . A recent study shows that High Flow Oxygen is non-inferior to Non Invasive Ventilation in post-extubation in patient with high risk of re-intubation. Furthermore, oxygenation in post-extubation should be optimized to avoid hypoxemia and hypercapnia in this patient at risk of hypoventilation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
55
HFO is a mix tap of air and oxygen. It permits to control FiO2 and generated controlled high flow air until 60/min. Air and oxygen are mixed, warmed, humidified and issued to patient by a warming monopod inspiratory circuit to nasal cannulas of a large diameter. Expiration is free.
NIV was already evaluated in post-extubation. This technic is now used in daily consolidation processing after extubation because it provides a ventilator help with two levels of pressure helping in respiratory work. Adding Automated Flow Oxygen Titration could optimized patient's oxygenation and reduce workload of caregivers.
CHU Larrey
Toulouse, France
Primary outcome: Tolerance of each dispositive
Comfort scale (from 0 to 100 : 0 is totally uncomfortable - 100 : comfortable)
Time frame: Hours 0
Primary outcome: Tolerance of each dispositive
Comfort scale (from 0 to 100 : 0 is totally uncomfortable - 100 : comfortable)
Time frame: Hours 6
Primary outcome: Tolerance of each dispositive
Comfort scale (from 0 to 100 : 0 is totally uncomfortable - 100 : comfortable)
Time frame: Hours 24
Primary outcome: Tolerance of each dispositive
Comfort scale (from 0 to 100 : 0 is totally uncomfortable - 100 : comfortable)
Time frame: Hours 48
Dyspnea scale of Borg
Dyspnea score which is a quantitative measure of the perception of effort during a physical exercise. The measure is a rating on a scale from 0 to 10 attached to different words of appreciation: "very light, difficult, painful ..." effort. This global measurement, based on the physical and psychological sensations of the person, takes into account the physical condition, the environmental conditions and the level of general fatigue. The scale between 0 and 10 was designed to approximate the heart rate of a healthy young adult (effort 8 represents 80% of the CF).
Time frame: Hours 6
Dyspnea scale of Borg
Dyspnea score which is a quantitative measure of the perception of effort during a physical exercise. The measure is a rating on a scale from 0 to 10 attached to different words of appreciation: "very light, difficult, painful ..." effort. This global measurement, based on the physical and psychological sensations of the person, takes into account the physical condition, the environmental conditions and the level of general fatigue. The scale between 0 and 10 was designed to approximate the heart rate of a healthy young adult (effort 8 represents 80% of the CF).
Time frame: Hours 24
Dyspnea scale of Borg
Dyspnea score which is a quantitative measure of the perception of effort during a physical exercise. The measure is a rating on a scale from 0 to 10 attached to different words of appreciation: "very light, difficult, painful ..." effort. This global measurement, based on the physical and psychological sensations of the person, takes into account the physical condition, the environmental conditions and the level of general fatigue. The scale between 0 and 10 was designed to approximate the heart rate of a healthy young adult (effort 8 represents 80% of the CF).
Time frame: Hours 48
Treatment's failure defined as use of NVI in HFO group or use of HFO in NVI group
defined by reintubation or exchange of treatment or premature discontinuation of treatment
Time frame: Month 3
Hematosis : PaO2, PaCO2, pH
Measurement of PaO2, PaCO2 and pH
Time frame: hours 6
Hematosis : PaO2, PaCO2, pH
Measurement of PaO2, PaCO2 and pH
Time frame: hours 24
Hematosis : PaO2, PaCO2, pH
Measurement of PaO2, PaCO2 and pH
Time frame: hours 48
Duration of hospitalization in intensive care units, reanimation, hospital after extubation.
Measurement of hospitalization in intensive care units in days
Time frame: Month 3
Mortality in ICU (continuous monitoring unit)
Measurement of mortality
Time frame: Month 3
Mortality in hospital
Measurement of mortality
Time frame: Month 3
Mortality at M1 and M3
Measurement of mortality
Time frame: Month 1
Mortality at M1 and M3
Measurement of mortality
Time frame: Month 3
Use of another technic (HFO or NVI) in time
Duration of use of the device (VNI, OHD) at H72
Time frame: hours 72
Respiratory congestion (number of fibroscopy for airway's desobstruction, number of respiratory kinesitherapy consults, radiological atelectasis)
Measurement of respiratory congestion by : number of fibroscopy for airway's desobstruction, number of respiratory kinesitherapy consults and radiological atelectasis
Time frame: month 3
New intubation rate at H48
New intubation rate at H48
Time frame: Hours 48
New intubation rate at H72
New intubation rate at H72
Time frame: Hours 72
SpO2 stability
Percentage of time spent below 88% and above 92% of SpO2
Time frame: hours 48
SpO2 stability
Percentage of time spent below 88% and above 92% of SpO2
Time frame: hours 72
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