A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients.

Parke RL, McGuinness SP, Eccleston, ML.

Respiratory Care 2011; 56(3):265-70.

AIM

To compare the effectiveness of Optiflow (nasal high flow) oxygen therapy and standard high-flow face mask (HFFM) oxygen therapy using a prospective randomized comparative study in a cardiothoracic and vascular intensive care unit.


KEY FINDINGS

Optiflow has an increasing role as an option for respiratory therapy in the ICU.

Optiflow had greater success than HFFM oxygen therapy and resulted in fewer desaturations, for ICU patients with mild-to-moderate respiratory failure.



METHOD

60 patients with mild to moderate hypoxemic respiratory failure were enrolled and data from 56 patients was analyzed. Data recorded included patient demographics, APACHE II score, SOFA score, arterial blood gas values, respiratory rate and heart rate. Continuous SpO2 monitoring was used to capture oxygen desaturations.

The Optiflow group commenced therapy at 37°C, 44 mg H2O/L and 35 L/min. Flow and FiO2 were titrated to achieve arterial oxygen saturation ≥ 95%. The HFFM group commenced therapy at 31°C and 32 mg H2O/L, and was also titrated to achieve arterial oxygen saturation ≥ 95% (considered the “gold standard” for high flow face mask oxygen therapy).

The allocated therapy was considered successful if the patients were maintained on or weaned from their assigned therapy within 24 hours of enrollment. The authors analyzed the success of the allocated therapy, noninvasive ventilation (NIV) rate and oxygen desaturation within the 24 hour study period.


RESULTS

More patients in the Optiflow group (26/29 = 89.6%) succeeded on their allocated therapy compared with HFFM patients (15/27 = 55.5%) (P = 0.006).

The rate of NIV in the Optiflow group was 3/29 (10%) compared with 8/27 (30%) in the HFFM group (p=0.10). The difference was not statistically significant however it represents a trend which may be clinically significant and warrants further investigation.

Importantly, of the 12 patients who failed HFFM, 5 were switched to Optiflow as a “rescue therapy” to try and avoid NIV. Four of these were patients were able to avoid NIV by using Optiflow in this scenario.

Fewer oxygen desaturations occurred in the Optiflow group compared with the HFFM group (P = 0.009).


CONCLUSION

Optiflow was more successful than the “gold standard” HFFM in the management of mild to moderate hypoxemic respiratory failure.

Optiflow resulted in fewer oxygen desaturations compared to HFFM (this reflects better compliance leading to better therapy delivery)

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