title: High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure.
abstract: BACKGROUND
  Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.
  
  
  METHODS
  We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28.
  
  
  RESULTS
  A total of 310 patients were included in the analyses. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P=0.18 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24±8 days, vs. 22±10 in the standard-oxygen group and 19±12 in the noninvasive-ventilation group; P=0.02 for all comparisons). The hazard ratio for death at 90 days was 2.01 (95% confidence interval [CI], 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P=0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P=0.006).
  
  
  CONCLUSIONS
  In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health; FLORALI ClinicalTrials.gov number, NCT01320384.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Christophe
authors.initials: C
authors.lastname: Girault
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ragot
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Gwénael
authors.initials: G
authors.lastname: Prat
authors.forename: Thierry
authors.initials: T
authors.lastname: Boulain
authors.forename: Elise
authors.initials: E
authors.lastname: Morawiec
authors.forename: Alice
authors.initials: A
authors.lastname: Cottereau
authors.forename: Jérôme
authors.initials: J
authors.lastname: Devaquet
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.forename: Keyvan
authors.initials: K
authors.lastname: Razazi
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Chakarian
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Chevalier
authors.forename: Alexandre
authors.initials: A
authors.lastname: Herbland
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tonnelier
authors.forename: Marc
authors.initials: M
authors.lastname: Pierrot
authors.forename: Armelle
authors.initials: A
authors.lastname: Mathonnet
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Béduneau
authors.forename: Céline
authors.initials: C
authors.lastname: Delétage-Métreau
authors.forename: Jean-Christophe M
authors.initials: JC
authors.lastname: Richard
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: René
authors.initials: R
authors.lastname: Robert
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D010100:Oxygen