Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, 30 bd Jean Monnet, 44093, Nantes, France.
Intensive Care Med. 2015 Sep;41(9):1538-48. doi: 10.1007/s00134-015-3796-z. Epub 2015 Apr 14.
Intubation of hypoxemic patients is associated with life-threatening adverse events. High-flow therapy by nasal cannula (HFNC) for preoxygenation before intubation has never been assessed by randomized study. Our objective was to evaluate the efficiency of HFNC for preoxygenation, compared to high fraction-inspired oxygen facial mask (HFFM).
Multicenter, randomized, open-labelled, controlled PREOXYFLOW trial (NCT 01747109) in six French intensive care units. Acute hypoxemic adults requiring intubation were randomly allocated to HFNC or HFFM. Patients were eligible if PaO2/FiO2 ratio was below 300 mmHg, respiratory rate at least 30/min and if they required FiO2 50% or more to obtain at least 90% oxygen saturation. HFNC was maintained throughout the procedure, whereas HFFM was removed at the end of general anaesthesia induction. Primary outcome was the lowest saturation throughout intubation procedure. Secondary outcomes included adverse events related to intubation, duration of mechanical ventilation and death.
A total of 124 patients were randomized. In the intent-to-treat analysis, including 119 patients (HFNC n = 62; HFFM n = 57), the median (interquartile range) lowest saturation was 91.5% (80-96) for HFNC and 89.5% (81-95) for the HFFM group (p = 0.44). There was no difference for difficult intubation (p = 0.18), intubation difficulty scale, ventilation-free days (p = 0.09), intubation-related adverse events including desaturation <80% or mortality (p = 0.46).
Compared to HFFM, HFNC as a preoxygenation device did not reduce the lowest level of desaturation.
低氧血症患者的插管与危及生命的不良事件有关。鼻导管（HFNC）高流量治疗用于插管前预充氧从未通过随机研究评估过。我们的目的是评估 HFNC 用于预充氧的效率，与高吸氧分数面罩（HFFM）相比。
在法国六个重症监护病房进行的多中心、随机、开放标签、对照 PREOXYFLOW 试验（NCT 01747109）。需要插管的急性低氧血症成人患者被随机分配到 HFNC 或 HFFM 组。如果 PaO2/FiO2 比值低于 300mmHg、呼吸频率至少为 30/min，并且需要 FiO2 50%或更高才能获得至少 90%的氧饱和度，则患者符合条件。HFNC 在整个过程中保持，而 HFFM 在全身麻醉诱导结束时被移除。主要结局是整个插管过程中最低的饱和度。次要结局包括与插管相关的不良事件、机械通气时间和死亡。
共有 124 名患者被随机分配。在意向治疗分析中，包括 119 名患者（HFNC 组 n=62；HFFM 组 n=57），HFNC 组的最低饱和度中位数（四分位间距）为 91.5%（80-96），HFFM 组为 89.5%（81-95）（p=0.44）。两组之间的困难插管（p=0.18）、插管困难评分、无通气天数（p=0.09）、包括饱和度<80%或死亡率的插管相关不良事件（p=0.46）无差异。
与 HFFM 相比，HFNC 作为预充氧设备并不能降低最低的脱氧程度。
