High-flow Oxygen Therapy Versus Non-invasive Ventilation: a Randomised Physiological Cross-over Study of Alveolar Recruitment in Acute Respiratory Failure
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 16
- 试验地点
- 1
- 主要终点
- global EELI
研究概览
简要总结
This physiological study showed an increase in regional ventilation with NIV but no difference in alveolar recruitment as compared to HFNC in patients with hypoxemic ARF. Although NIV provided better oxygenation than HFNC, the effect on lung volumes could explain the potentially deleterious effect of NIV in hypoxemic ARF, reinforcing the recently developed concept of patient self-inflicted lung injury.
详细描述
Background: High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).
研究设计
- 研究类型
- Observational
- 观察模型
- Case Crossover
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients referred in ICU
- •with hypoxemic acute respiratory failure due to a community acquired pneumonia confirmed by chest X ray,
- •with PaO2 < 60mmHg in ambient air, without hypercapnia (PaCO2 < 45 mmHg),
- •requiring more than 6L/min of O2 on admission with high concentration FM, and justifying HFNC or NIV for the attending ICU physician
排除标准
- •cardiogenic pulmonary oedema,
- •moderate to severe underlying respiratory disease including COPD (chronic obstructive pulmonary disease)
- •contraindication to or failure of previous NIV or HFNC with the need for immediate invasive ventilation
- •pregnant or breast-feeding women
- •carrier of an implantable defibrillator or pacemaker
- •body mass index (BMI)>50 kg/m2
- •with cutaneous lesion next to the positioning zone of the Pulmovista® (Dräger, Lübeck, Germany) belt
结局指标
主要结局
global EELI
时间窗: after 5 minutes of stable breathing with the oxygenation technic
measurement of global end respiratory lung impedance with non invasive ventilation vs with high flow nasal canulae oxygen therapy, standard unit
次要结局
- ROI EELI(after 5 minutes of stable breathing with the oxygenation technic)
- global TV(after 5 minutes of stable breathing with the oxygenation technic)
- ROI TV(after 5 minutes of stable breathing with the oxygenation technic)