The investigators hypothesize that the airway pressures generated by High Flow Oxygen Therapy could have a beneficial impact in patients with heart failure, particularly by lowering capillary pulmonary arterial pressures. However, results compared to Non-Invasive Ventilation are difficult to predict due to the lack of data in the literature.
The investigators propose to carry out a prospective randomized cross-over prospective physiological study comparing, Non-Invasive Ventilation and High Flow Oxygen Therapy in patients with chronic uncompensated heart failure. This stable population would make it possible to easily study variations in a physiological parameter without any added risk for the patient, but with all the pathophysiological parameters transposable to the situation of decompensated heart failure. Indeed, it is accepted that the existence of heart failure with decreased left ventricular ejection fraction (LVEF) (\< 40%) exposes patients to a high risk of congestive cardiac decompensation due to the associated presence of diastolic dysfunction1. The study will be conducted using an alternating design, where a patient receives the two treatments one after the other ("cross-over"), because the alternating design, compared to the two parallel arm design, reduces the number of patients needed to show a given difference between High Flow Oxygen Therapy and Non-Invasive Ventilation at equal power, if there is neither an order-of-prescription effect ("period") nor a residual effect of the first treatment on the second treatment ("carry-over"). In order to avoid a residual effect on changes in pressure or oxygenation, a wash-out period on conventional oxygen therapy (O2C) should be set between the two treatments (High Flow Oxygen Therapy and Non-Invasive Ventilation) administered to the same patient.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
High-flow oxygen therapy + O2C + Non invasive ventilation
Non invasive ventilation + O2C + High-flow oxygen therapy
High-Flow Oxygen Therapy and Non Invasive Ventilation on left ventricular filling pressures
Difference between High-Flow Oxygen Therapy and Non Invasive Ventilation on left ventricular filling pressures as assessed by the occluded pulmonary artery occlusion pressure (in mmHg) measured by Swan-Ganz pulmonary artery catheterization
Time frame: Day 1
Comparison between High-Flow Oxygen Therapy and Non-Invasive ventilation w.r.t. ventricular function
Arterial pressure \[mmHg\] measured by Swan-Ganz catheter
Time frame: Day 1
Comparison between High-Flow Oxygen Therapy and Non-Invasive ventilation w.r.t. arterial oxygenation
Arterial oxygen saturation, SaO2 \[%\], measured by Swan-Ganz catheter
Time frame: Day 1
Comparison between High-Flow Oxygen Therapy and Non-Invasive ventilation w.r.t. change in pulmonary volume
End-expiratory lung impedance (mean of 3 measures), measured by PulmoVista (Draeger, Germany)
Time frame: Day 1
Patient comfort
Patient's evaluation of comfort on Visual Analog Scale (10 points)
Time frame: Day 1
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