Title :

Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial.

Author(s) :

Azoulay, Elie [Auteur]
Lemiale, Virginie [Auteur]
Mokart, Djamel [Auteur]
Nseir, Saad [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Arnaud, Laurent [Auteur]
Pene, Frederic [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
Kontar, Loay [Auteur]
Bruneel, Fabrice [Auteur]
Klouche, Kada [Auteur]
Barbier, Francois [Auteur]
Reignier, Jean [Auteur]
Berrahil-Meksen, Lilia [Auteur]
Louis, Guillaume [Auteur]
Constantin, Jean-Michel [Auteur]
Mayaux, Julien [Auteur]
Wallet, Florent [Auteur]
Kouatchet, Achille [Auteur]
Peigne, Vincent [Auteur]
Theodose, Igor [Auteur]
Perez, Pierre [Auteur]
Girault, Christophe [Auteur]
Jaber, Samir [Auteur]
Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] [PhyMedExp]
Oziel, Johanna [Auteur]
Nyunga, Martine [Auteur]
Terzi, Nicolas [Auteur]
Bouadma, Lila [Auteur]
Lebert, Christine [Auteur]
Lautrette, Alexandre [Auteur]
Bige, Naike [Auteur]
Raphalen, Jean-Herle [Auteur]
Papazian, Laurent [Auteur]
Aix Marseille Université [AMU]
Darmon, Michael [Auteur]
Chevret, Sylvie [Auteur]
Demoule, Alexandre [Auteur]

Journal title :

JAMA

Abbreviated title :

JAMA

Volume number :

320

Pages :

2099-2107

Publication date :

2018-11-27

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Importance: High-flow nasal oxygen therapy is increasingly used for acute hypoxemic respiratory failure (AHRF). Objective: To determine whether high-flow oxygen therapy decreases mortality among immunocompromised patients ...
Show more >Importance: High-flow nasal oxygen therapy is increasingly used for acute hypoxemic respiratory failure (AHRF). Objective: To determine whether high-flow oxygen therapy decreases mortality among immunocompromised patients with AHRF compared with standard oxygen therapy. Design, Setting, and Participants: The HIGH randomized clinical trial enrolled 776 adult immunocompromised patients with AHRF (Pao2 <60 mm Hg or Spo2 <90% on room air, or tachypnea >30/min or labored breathing or respiratory distress, and need for oxygen >/=6 L/min) at 32 intensive care units (ICUs) in France between May 19, 2016, and December 31, 2017. Interventions: Patients were randomized 1:1 to continuous high-flow oxygen therapy (n = 388) or to standard oxygen therapy (n = 388). Main Outcomes and Measures: The primary outcome was day-28 mortality. Secondary outcomes included intubation and mechanical ventilation by day 28, Pao2:Fio2 ratio over the 3 days after intubation, respiratory rate, ICU and hospital lengths of stay, ICU-acquired infections, and patient comfort and dyspnea. Results: Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial. At randomization, median respiratory rate was 33/min (IQR, 28-39) vs 32 (IQR, 27-38) and Pao2:Fio2 was 136 (IQR, 96-187) vs 128 (IQR, 92-164) in the intervention and control groups, respectively. Median SOFA score was 6 (IQR, 4-8) in both groups. Mortality on day 28 was not significantly different between groups (35.6% vs 36.1%; difference, -0.5% [95% CI, -7.3% to +6.3%]; hazard ratio, 0.98 [95% CI, 0.77 to 1.24]; P = .94). Intubation rate was not significantly different between groups (38.7% vs 43.8%; difference, -5.1% [95% CI, -12.3% to +2.0%]). Compared with controls, patients randomized to high-flow oxygen therapy had a higher Pao2:Fio2 (150 vs 119; difference, 19.5 [95% CI, 4.4 to 34.6]) and lower respiratory rate after 6 hours (25/min vs 26/min; difference, -1.8/min [95% CI, -3.2 to -0.2]). No significant difference was observed in ICU length of stay (8 vs 6 days; difference, 0.6 [95% CI, -1.0 to +2.2]), ICU-acquired infections (10.0% vs 10.6%; difference, -0.6% [95% CI, -4.6 to +4.1]), hospital length of stay (24 vs 27 days; difference, -2 days [95% CI, -7.3 to +3.3]), or patient comfort and dyspnea scores. Conclusions and Relevance: Among critically ill immunocompromised patients with acute respiratory failure, high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. Trial Registration: clinicaltrials.gov Identifier: NCT02739451.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Research team(s) :

Fungal associated invasive and inflammatory diseases

Submission date :

2019-03-01T14:07:54Z
2024-01-29T10:16:42Z