OptiTHO
Trial question
What is the role of prophylactic noninvasive ventilation and high-flow nasal oxygen therapy in hypoxemic blunt chest trauma patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
15.0% female
85.0% male
N = 141
141 patients (21 female, 120 male).
Inclusion criteria: adult patients admitted to the ICU within 48 hours after high-risk blunt chest trauma, non-severe hypoxemia, and no evidence of acute respiratory failure.
Key exclusion criteria: need for emergency intubation; hypercapnia; previous surgical intervention by thoracotomy or laparotomy; contraindications for noninvasive ventilation; a DNI order.
Interventions
N=71 early noninvasive ventilation and high-flow nasal oxygen therapy (a prompt association of high-flow nasal oxygen therapy and early non-invasive ventilation in every patient for at least 48 hours).
N=70 late noninvasive ventilation and conventional oxygen therapy (conventional oxygen therapy and late noninvasive ventilation, indicated in patients with respiratory deterioration and/or ratio of arterial oxygen partial pressure to fractional inspired oxygen ≤ 200 mmHg).
Primary outcome
Endotracheal intubation for delayed respiratory failure
7%
8.6%
8.6 %
6.4 %
4.3 %
2.1 %
0.0 %
Early noninvasive ventilation and high-flow nasal oxygen
therapy
Late noninvasive ventilation and conventional oxygen
therapy
No significant
difference ↔
No significant difference in endotracheal intubation for delayed respiratory failure (7% vs. 8.6%; OR 0.72, 95% CI 0.2 to 2.43).
Safety outcomes
No significant difference in secondary pneumothorax or vomiting/aspiration.
Significant difference in excessive agitation with need for sedatives or noninvasive ventilation removal (21% vs. 3%).
Conclusion
In adult patients admitted to the ICU within 48 hours after high-risk blunt chest trauma, non-severe hypoxemia, and no evidence of acute respiratory failure, early noninvasive ventilation and high-flow nasal oxygen therapy were not superior to late noninvasive ventilation and conventional oxygen therapy with respect to endotracheal intubation for delayed respiratory failure.
Reference
Cédric Carrié, Benjamin Rieu, Antoine Benard et al. Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial. Crit Care. 2023 Apr 26;27(1):163.
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