PREOXYFLOW
Trial question
What is the role of high-flow therapy by nasal cannula for preoxygenation in patients with acute hypoxemia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 119
119 patients (41 female, 78 male).
Inclusion criteria: adult patients with acute hypoxemia requiring intubation.
Key exclusion criteria: contraindication to orotracheal intubation; intubation without anesthetic rapid sequence induction; intubation for cardiac arrest; asphyxia requiring immediate intubation; nasopharyngeal obstacle; Grade 4 glottis exposure on the Cormack-Lehane scale.
Interventions
N=62 high-flow nasal cannula (for preoxygenation before intubation).
N=57 high fraction-inspired oxygen facial mask.
Primary outcome
Oxygen saturation at its lowest during intubation procedure
91.5%
89.5%
91.5 %
68.6 %
45.8 %
22.9 %
0.0 %
High-flow nasal
cannula
High fraction-inspired oxygen facial
mask
No significant
difference ↔
No significant difference in oxygen saturation at its lowest during the intubation procedure (91.5% vs. 89.5%; AD 2%, 95% CI -2.99 to 6.99).
Secondary outcomes
No significant difference in ventilator-free days (14 days vs. 5 days; AD 9 days, 95% CI -1.41 to 19.41).
No significant difference in difficult intubation (1.6% vs. 7.1%; ARD -5.5, 95% CI -13.52 to 2.52).
No significant difference in death at day 28 (35.4% vs. 42.1%; ARD -6.7, 95% CI -24.9 to 11.5).
Safety outcomes
No significant differences in ventilator-associated pneumonia, intubation-related adverse events including desaturation.
Conclusion
In adult patients with acute hypoxemia requiring intubation, high-flow nasal cannula was not superior to high fraction-inspired oxygen facial mask with respect to oxygen saturation at its lowest during the intubation procedure.
Reference
Mickaël Vourc'h, Pierre Asfar, Christelle Volteau et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015 Sep;41(9):1538-48.
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