Title :

Predictors of Intubation in Patients With Acute Hypoxemic Respiratory Failure Treated With a Noninvasive Oxygenation Strategy

Author(s) :

Frat, Jean-Pierre [Auteur]
Université de Poitiers = University of Poitiers [UP]
Ragot, Stephanie [Auteur]
Université de Poitiers = University of Poitiers [UP]
Coudroy, Remi [Auteur]
Université de Poitiers = University of Poitiers [UP]
Constantin, Jean-Michel [Auteur]
Girault, Christophe [Auteur]
Prat, Gwenael [Auteur]
Boulain, Thierry [Auteur]
Demoule, Alexandre [Auteur]
Université Pierre et Marie Curie - Paris 6 [UPMC]
Ricard, Jean-Damien [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Razazi, Keyvan [Auteur]
Lascarrou, Jean-Baptiste [Auteur]
Devaquet, Jerome [Auteur]
Mira, Jean-Paul [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
Arnaud, Laurent [Auteur]
Chakarian, Jean-Charles [Auteur]
Fartoukh, Muriel [Auteur]
Nseir, Saad [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Mercat, Alain [Auteur]
Brochard, Laurent [Auteur]
Robert, Rene [Auteur]
Université de Poitiers = University of Poitiers [UP]
Thille, Arnaud W [Auteur]
Université de Poitiers = University of Poitiers [UP]

Journal title :

Critical Care Medicine

Abbreviated title :

Crit. Care Med.

Volume number :

46

Pages :

208-215

Publication date :

2018-02

ISSN :

0090-3493

Keyword(s) :

high-flow oxygen therapy
intubation
noninvasive ventilation
high-flow nasal cannula
acute respiratory failure

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Objectives: In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently ...
Show more >Objectives: In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently needed in these patients with a risk of delay, and early predictors of failure may help clinicians to decide early. We aimed to identify factors associated with intubation in patients with acute hypoxemic respiratory failure treated with different noninvasive oxygenation techniques. Design: Post hoc analysis of a randomized clinical trial. Setting: Twenty-three ICUs. Patients: Patients with a respiratory rate greater than 25 breaths/min and a Pao2/Fio2 ratio less than or equal to 300 mm Hg. Intervention: Patients were treated with standard oxygen, high-flow nasal cannula oxygen, or noninvasive ventilation. Measurement and Main Results: Respiratory variables one hour after treatment initiation. Under standard oxygen, patients with a respiratory rate greater than or equal to 30 breaths/min were more likely to need intubation (odds ratio, 2.76; 95% CI, 1.13–6.75; p = 0.03). One hour after high-flow nasal cannula oxygen initiation, increased heart rate was the only factor associated with intubation. One hour after noninvasive ventilation initiation, a Pao2/Fio2 ratio less than or equal to 200 mm Hg and a tidal volume greater than 9 mL/kg of predicted body weight were independent predictors of intubation (adjusted odds ratio, 4.26; 95% CI, 1.62–11.16; p = 0.003 and adjusted odds ratio, 3.14; 95% CI, 1.22–8.06; p = 0.02, respectively). A tidal volume above 9 mL/kg during noninvasive ventilation remained independently associated with 90-day mortality. Conclusions: In patients with acute hypoxemic respiratory failure breathing spontaneously, the respiratory rate was a predictor of intubation under standard oxygen, but not under high-flow nasal cannula oxygen or noninvasive ventilation. A Pao2/Fio2 below 200 mm Hg and a high tidal volume greater than 9 mL/kg were the two strong predictors of intubation under noninvasive ventilation.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 :

2019-03-01T14:35:16Z
2023-12-07T09:52:57Z