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Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

R. Robert 1, 2 D. Frasca 2, 3, 4 J. Badin 5 C. Girault 6 C. Guitton 7 M. Djibre 8 P. Beuret 9 J. Reignier 10 D. Benzekri-Llefevre 11 S. Demiri 12, 13 H. Rahmani 14, 15 L. A. Argaud 16, 17 E. I'Her 18, 19 S. Ehrmann 20, 21, 22 O. Lesieur 23 K. Kuteifan 24 F. Thouy 25 L. Federici 26 D. Thevenin 27 D. Contou 28 N. Terzi 29 S. Nseir 30 M. Thyrault 31 C. Vinsonneau 32 J. Audibert 33 J. Masse 34 A. Boyer 35 B. Guidet 36 R. Chelha 37 J. P. Quenot 38 G. Piton 39, 40 N. Aissaoui 41 A. W. Thille 2, 1 J. P. Frat 1, 2
Abstract : INTRODUCTION: A palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient's quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders. METHODS AND ANALYSIS: This is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03673631.
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Submitted on : Monday, August 30, 2021 - 9:21:42 AM
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R. Robert, D. Frasca, J. Badin, C. Girault, C. Guitton, et al.. Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL. BMJ Open, BMJ Publishing Group, 2021, 11 (2), pp.e045659. ⟨10.1136/bmjopen-2020-045659⟩. ⟨inserm-03328426⟩

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