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High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial
Background: The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation...
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Published in: | Therapeutic advances in respiratory disease 2020, Vol.14, p.1753466620956459-1753466620956459 |
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description | Background:
The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation in this group of patients.
Methods:
An open-label, controlled and single-centre clinical trial was conducted in patients with severe AHRF, defined by a PaO2/FIO2 ratio ⩽200, to compare HFNC with a control group (CG) treated by COT delivered through a face mask, with the need to perform intubation as the primary outcome. The secondary outcomes included tolerance of the HFNC device and to look for the predictive factors for intubation in these patients.
Results:
A total of 46 patients were included (22 in the COT group and 24 in the HFNC group) 48% of whom needed intubation: 63% in the COT group and 33% in the HFNC group, with significant differences both in intention to treat [χ2 = 4.2; p = 0.04, relative risk (RR) = 0.5; confidence interval (CI) 95%: 0.3–1.0] and also in treatment analysis (χ2 = 4.7; p = 0.03; RR = 0.5; IC 95%: 0.3–0.9) We obtained a number needed to treat (NNT) = 3 patients treated to avoid an intubation. Intubation occurred significantly later in the HFNC group. Estimated PaO2/FIO2, respiratory rate and dyspnea were significantly better in the HFNC group. Patients treated with HFNC who required intubation presented significant worsening after the first 8 h, as compared with non-intubated HFNC group patients. Mortality was 22% with no differences. The HFNC group patients were hospitalized for almost half of the time in the intensive care unit (ICU) and in the ward, with significantly less hospital length of stay. A total of 14 patients in the HFNC group (58%) complained of excessive heat and 17% of noise; 3 patients did not tolerate HFNC.
Conclusion:
Patients with severe acute hypoxemic respiratory failure who tolerate HFNC present a significantly lower need for endotracheal intubation compared with conventional oxygen therapy.
Clinical Trial Register
EUDRA CT number: 2012-001671-36
The reviews of this paper are available via the supplemental material section. |
doi_str_mv | 10.1177/1753466620956459 |
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The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation in this group of patients.
Methods:
An open-label, controlled and single-centre clinical trial was conducted in patients with severe AHRF, defined by a PaO2/FIO2 ratio ⩽200, to compare HFNC with a control group (CG) treated by COT delivered through a face mask, with the need to perform intubation as the primary outcome. The secondary outcomes included tolerance of the HFNC device and to look for the predictive factors for intubation in these patients.
Results:
A total of 46 patients were included (22 in the COT group and 24 in the HFNC group) 48% of whom needed intubation: 63% in the COT group and 33% in the HFNC group, with significant differences both in intention to treat [χ2 = 4.2; p = 0.04, relative risk (RR) = 0.5; confidence interval (CI) 95%: 0.3–1.0] and also in treatment analysis (χ2 = 4.7; p = 0.03; RR = 0.5; IC 95%: 0.3–0.9) We obtained a number needed to treat (NNT) = 3 patients treated to avoid an intubation. Intubation occurred significantly later in the HFNC group. Estimated PaO2/FIO2, respiratory rate and dyspnea were significantly better in the HFNC group. Patients treated with HFNC who required intubation presented significant worsening after the first 8 h, as compared with non-intubated HFNC group patients. Mortality was 22% with no differences. The HFNC group patients were hospitalized for almost half of the time in the intensive care unit (ICU) and in the ward, with significantly less hospital length of stay. A total of 14 patients in the HFNC group (58%) complained of excessive heat and 17% of noise; 3 patients did not tolerate HFNC.
Conclusion:
Patients with severe acute hypoxemic respiratory failure who tolerate HFNC present a significantly lower need for endotracheal intubation compared with conventional oxygen therapy.
Clinical Trial Register
EUDRA CT number: 2012-001671-36
The reviews of this paper are available via the supplemental material section.</description><identifier>ISSN: 1753-4666</identifier><identifier>ISSN: 1753-4658</identifier><identifier>EISSN: 1753-4666</identifier><identifier>DOI: 10.1177/1753466620956459</identifier><identifier>PMID: 32976085</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Clinical trials ; Intubation ; Original Research ; Oxygen therapy ; Respiratory failure</subject><ispartof>Therapeutic advances in respiratory disease, 2020, Vol.14, p.1753466620956459-1753466620956459</ispartof><rights>The Author(s), 2020</rights><rights>The Author(s), 2020. This work is licensed under the Creative Commons Attribution – Non-Commercial License https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s), 2020 2020 SAGE Publications Ltd unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c505t-430caa1ce4b2ead3e328625deda0c3fa25dcebffaaf4ef1b17ebb44acffa39a13</citedby><cites>FETCH-LOGICAL-c505t-430caa1ce4b2ead3e328625deda0c3fa25dcebffaaf4ef1b17ebb44acffa39a13</cites><orcidid>0000-0002-5496-0395</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522841/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2473725389?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,4024,21966,25753,27853,27923,27924,27925,37012,37013,44590,44945,45333,53791,53793</link.rule.ids></links><search><creatorcontrib>Andino, Ricardo</creatorcontrib><creatorcontrib>Vega, Gema</creatorcontrib><creatorcontrib>Pacheco, Sandra Karina</creatorcontrib><creatorcontrib>Arevalillo, Nuria</creatorcontrib><creatorcontrib>Leal, Ana</creatorcontrib><creatorcontrib>Fernández, Laura</creatorcontrib><creatorcontrib>Rodriguez, María Jesús</creatorcontrib><title>High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial</title><title>Therapeutic advances in respiratory disease</title><addtitle>Ther Adv Respir Dis</addtitle><description>Background:
The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation in this group of patients.
Methods:
An open-label, controlled and single-centre clinical trial was conducted in patients with severe AHRF, defined by a PaO2/FIO2 ratio ⩽200, to compare HFNC with a control group (CG) treated by COT delivered through a face mask, with the need to perform intubation as the primary outcome. The secondary outcomes included tolerance of the HFNC device and to look for the predictive factors for intubation in these patients.
Results:
A total of 46 patients were included (22 in the COT group and 24 in the HFNC group) 48% of whom needed intubation: 63% in the COT group and 33% in the HFNC group, with significant differences both in intention to treat [χ2 = 4.2; p = 0.04, relative risk (RR) = 0.5; confidence interval (CI) 95%: 0.3–1.0] and also in treatment analysis (χ2 = 4.7; p = 0.03; RR = 0.5; IC 95%: 0.3–0.9) We obtained a number needed to treat (NNT) = 3 patients treated to avoid an intubation. Intubation occurred significantly later in the HFNC group. Estimated PaO2/FIO2, respiratory rate and dyspnea were significantly better in the HFNC group. Patients treated with HFNC who required intubation presented significant worsening after the first 8 h, as compared with non-intubated HFNC group patients. Mortality was 22% with no differences. The HFNC group patients were hospitalized for almost half of the time in the intensive care unit (ICU) and in the ward, with significantly less hospital length of stay. A total of 14 patients in the HFNC group (58%) complained of excessive heat and 17% of noise; 3 patients did not tolerate HFNC.
Conclusion:
Patients with severe acute hypoxemic respiratory failure who tolerate HFNC present a significantly lower need for endotracheal intubation compared with conventional oxygen therapy.
Clinical Trial Register
EUDRA CT number: 2012-001671-36
The reviews of this paper are available via the supplemental material section.</description><subject>Clinical trials</subject><subject>Intubation</subject><subject>Original Research</subject><subject>Oxygen therapy</subject><subject>Respiratory failure</subject><issn>1753-4666</issn><issn>1753-4658</issn><issn>1753-4666</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1kUtv1TAQhSMEoqWwZxmJDZuAn3HCAglVhVaqxKJlbU2cca6vfO1iJ4X21-NwK_qQWHl05sw3M56qekvJB0qV-kiV5KJtW0Z62QrZP6sOV6lZtecP4oPqVc5bQmRPVPeyOuCsVy3p5GF1ceqmTWN9_FUHyODr-PtmwlAnHBeDucYwxjmB2WDJuTAvA8wuhk811AlKbuducayNd8GZ4piTA_-6emHBZ3xz9x5VP76eXB6fNuffv50dfzlvjCRybgQnBoAaFANDGDly1rVMjjgCMdxCCQ0O1gJYgZYOVOEwCAGmSLwHyo-qsz13jLDVV8ntIN3oCE7_FWKaNKTZGY_ajKSzA0fRqV5AX5CUW0IZQdsrQ0Rhfd6zrpZhh6VxKFv7R9DHmeA2eorXWknGOrEO8_4OkOLPBfOsdy4b9B4CxiVrJtZDCNmtvd49sW7jkkL5quJSXDHJu764yN5lUsw5of03DCV6vb5-ev1S0uxLMkx4D_2v_w-htrBF</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Andino, Ricardo</creator><creator>Vega, Gema</creator><creator>Pacheco, Sandra Karina</creator><creator>Arevalillo, Nuria</creator><creator>Leal, Ana</creator><creator>Fernández, Laura</creator><creator>Rodriguez, María Jesús</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><general>SAGE Publishing</general><scope>AFRWT</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5496-0395</orcidid></search><sort><creationdate>2020</creationdate><title>High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial</title><author>Andino, Ricardo ; Vega, Gema ; Pacheco, Sandra Karina ; Arevalillo, Nuria ; Leal, Ana ; Fernández, Laura ; Rodriguez, María Jesús</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c505t-430caa1ce4b2ead3e328625deda0c3fa25dcebffaaf4ef1b17ebb44acffa39a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Clinical trials</topic><topic>Intubation</topic><topic>Original Research</topic><topic>Oxygen therapy</topic><topic>Respiratory failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Andino, Ricardo</creatorcontrib><creatorcontrib>Vega, Gema</creatorcontrib><creatorcontrib>Pacheco, Sandra Karina</creatorcontrib><creatorcontrib>Arevalillo, Nuria</creatorcontrib><creatorcontrib>Leal, Ana</creatorcontrib><creatorcontrib>Fernández, Laura</creatorcontrib><creatorcontrib>Rodriguez, María Jesús</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Therapeutic advances in respiratory disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Andino, Ricardo</au><au>Vega, Gema</au><au>Pacheco, Sandra Karina</au><au>Arevalillo, Nuria</au><au>Leal, Ana</au><au>Fernández, Laura</au><au>Rodriguez, María Jesús</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial</atitle><jtitle>Therapeutic advances in respiratory disease</jtitle><addtitle>Ther Adv Respir Dis</addtitle><date>2020</date><risdate>2020</risdate><volume>14</volume><spage>1753466620956459</spage><epage>1753466620956459</epage><pages>1753466620956459-1753466620956459</pages><issn>1753-4666</issn><issn>1753-4658</issn><eissn>1753-4666</eissn><abstract>Background:
The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation in this group of patients.
Methods:
An open-label, controlled and single-centre clinical trial was conducted in patients with severe AHRF, defined by a PaO2/FIO2 ratio ⩽200, to compare HFNC with a control group (CG) treated by COT delivered through a face mask, with the need to perform intubation as the primary outcome. The secondary outcomes included tolerance of the HFNC device and to look for the predictive factors for intubation in these patients.
Results:
A total of 46 patients were included (22 in the COT group and 24 in the HFNC group) 48% of whom needed intubation: 63% in the COT group and 33% in the HFNC group, with significant differences both in intention to treat [χ2 = 4.2; p = 0.04, relative risk (RR) = 0.5; confidence interval (CI) 95%: 0.3–1.0] and also in treatment analysis (χ2 = 4.7; p = 0.03; RR = 0.5; IC 95%: 0.3–0.9) We obtained a number needed to treat (NNT) = 3 patients treated to avoid an intubation. Intubation occurred significantly later in the HFNC group. Estimated PaO2/FIO2, respiratory rate and dyspnea were significantly better in the HFNC group. Patients treated with HFNC who required intubation presented significant worsening after the first 8 h, as compared with non-intubated HFNC group patients. Mortality was 22% with no differences. The HFNC group patients were hospitalized for almost half of the time in the intensive care unit (ICU) and in the ward, with significantly less hospital length of stay. A total of 14 patients in the HFNC group (58%) complained of excessive heat and 17% of noise; 3 patients did not tolerate HFNC.
Conclusion:
Patients with severe acute hypoxemic respiratory failure who tolerate HFNC present a significantly lower need for endotracheal intubation compared with conventional oxygen therapy.
Clinical Trial Register
EUDRA CT number: 2012-001671-36
The reviews of this paper are available via the supplemental material section.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>32976085</pmid><doi>10.1177/1753466620956459</doi><orcidid>https://orcid.org/0000-0002-5496-0395</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Clinical trials Intubation Original Research Oxygen therapy Respiratory failure |
title | High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial |
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