High-flow Oxygen Therapy vs Non-invasive Ventilation: Comparison of Alveolar Recruitment in Acute Respiratory Failure

University Hospital, Rouen16 enrolled

Overview

This physiological study showed an increase in regional ventilation with NIV but no difference in alveolar recruitment as compared to HFNC in patients with hypoxemic ARF. Although NIV provided better oxygenation than HFNC, the effect on lung volumes could explain the potentially deleterious effect of NIV in hypoxemic ARF, reinforcing the recently developed concept of patient self-inflicted lung injury.

Background: High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Acute Respiratory Failure With Hypoxia

Interventions

non invasive ventilation and high flow nasal canulae oxygen therapyDEVICE

patients with hypoxemic acute respiratory failure received alternatively non invasive ventilation and high flow nasal canulae oxygen therapy

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients referred in ICU * with hypoxemic acute respiratory failure due to a community acquired pneumonia confirmed by chest X ray, * with PaO2 \< 60mmHg in ambient air, without hypercapnia (PaCO2 \< 45 mmHg), * requiring more than 6L/min of O2 on admission with high concentration FM, and justifying HFNC or NIV for the attending ICU physician Exclusion Criteria: * cardiogenic pulmonary oedema, * moderate to severe underlying respiratory disease including COPD (chronic obstructive pulmonary disease) * contraindication to or failure of previous NIV or HFNC with the need for immediate invasive ventilation * pregnant or breast-feeding women * carrier of an implantable defibrillator or pacemaker * body mass index (BMI)\>50 kg/m2 * with cutaneous lesion next to the positioning zone of the Pulmovista® (Dräger, Lübeck, Germany) belt

Outcomes

Primary Outcomes

global EELI

measurement of global end respiratory lung impedance with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit

Time frame: after 5 minutes of stable breathing with the oxygenation technic

Secondary Outcomes

ROI EELI

measurement of regional of interest (ROI) end respiratory lung impedance with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit

Time frame: after 5 minutes of stable breathing with the oxygenation technic

global TV

measurement of global tidal variation (TV) with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit

Time frame: after 5 minutes of stable breathing with the oxygenation technic

ROI TV

measurement of regional tidal variation with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit

Time frame: after 5 minutes of stable breathing with the oxygenation technic

Data from ClinicalTrials.gov

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