1
|
Kwizera A, Kabatoro D, Owachi D, Kansiime J, Kateregga G, Nanyunja D, Sendagire C, Nyakato D, Olaro C, Audureau E, Mekontso Dessap A. Respiratory support with standard low-flow oxygen therapy, high-flow oxygen therapy or continuous positive airway pressure in adults with acute hypoxaemic respiratory failure in a resource-limited setting: protocol for a randomised, open-label, clinical trial - the Acute Respiratory Intervention StudiEs in Africa (ARISE-AFRICA) study. BMJ Open 2024; 14:e082223. [PMID: 38951007 PMCID: PMC11218023 DOI: 10.1136/bmjopen-2023-082223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/19/2024] [Indexed: 07/03/2024] Open
Abstract
RATIONALE Acute hypoxaemic respiratory failure (AHRF) is associated with high mortality in sub-Saharan Africa. This is at least in part due to critical care-related resource constraints including limited access to invasive mechanical ventilation and/or highly skilled acute care workers. Continuous positive airway pressure (CPAP) and high-flow oxygen by nasal cannula (HFNC) may prove useful to reduce intubation, and therefore, improve survival outcomes among critically ill patients, particularly in resource-limited settings, but data in such settings are lacking. The aim of this study is to determine whether CPAP or HFNC as compared with standard oxygen therapy, could reduce mortality among adults presenting with AHRF in a resource-limited setting. METHODS This is a prospective, multicentre, randomised, controlled, stepped wedge trial, in which patients presenting with AHRF in Uganda will be randomly assigned to standard oxygen therapy delivered through a face mask, HFNC oxygen or CPAP. The primary outcome is all-cause mortality at 28 days. Secondary outcomes include the number of patients with criteria for intubation at day 7, the number of patients intubated at day 28, ventilator-free days at day 28 and tolerance of each respiratory support. ETHICS AND DISSEMINATION The study has obtained ethical approval from the Research and Ethics Committee, School of Biomedical Sciences, College of Health Sciences, Makerere University as well as the Uganda National Council for Science and Technology. Patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04693403. PROTOCOL VERSION 8 September 2023; version 5.
Collapse
Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daphne Kabatoro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- Department of Emergency Medicine, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Jackson Kansiime
- Department of Internal Medicine, St Mary's Hospital, Gulu, Uganda
| | - George Kateregga
- Department of Anaesthesia and Intensive Care, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doreen Nanyunja
- Department of Internal Medicine, China-Uganda Friendship Hospital Naguru, Kampala, Uganda
| | | | | | | | - Etienne Audureau
- CEPIA EA7376, Universite Paris-Est Creteil Val de Marne, Creteil, France
| | | |
Collapse
|
2
|
Girault C, Boyer D, Jolly G, Carpentier D, Béduneau G, Frat JP. Principes de fonctionnement, effets physiologiques et aspects pratiques de l’oxygénothérapie à haut débit. Rev Mal Respir 2022; 39:455-468. [DOI: 10.1016/j.rmr.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/27/2022] [Indexed: 12/29/2022]
|
3
|
Girault C, Artaud-Macari E. L’oxygénothérapie nasale à haut débit dans l’insuffisance respiratoire aiguë : de la physiologie à « l’evidence-based medicine » ! Rev Mal Respir 2022; 39:315-318. [DOI: 10.1016/j.rmr.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
Frat JP, Coudroy R, Thille A. Y a-t-il une place pour l’oxygénothérapie nasale à haut débit dans l’insuffisance respiratoire aiguë? Oui. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
5
|
Frat JP, Coudroy R, Marjanovic N, Thille AW. High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:297. [PMID: 28828372 DOI: 10.21037/atm.2017.06.52] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF. A recent multicenter randomized controlled trial showed benefits of HFNC concerning mortality and intubation in severe patients with hypoxemic ARF. In management of patients with hypoxemic ARF, NIV results have been conflicting. Despite improved oxygenation, NIV delivered with face mask may generate high tidal volumes and subsequent ventilator-induced lung injury. An approach applying NIV with a helmet, high levels of positive end-expiratory pressure (PEEP) and low pressure support (PS) levels seems to open new opportunities in patients with hypoxemic ARF. However, a large-scale randomized controlled study is needed to assess and compare this approach with HFNC.
Collapse
Affiliation(s)
- Jean-Pierre Frat
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.,Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Rémi Coudroy
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.,Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Nicolas Marjanovic
- INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.,Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France.,CHU de Poitiers, Services des Urgences, Poitiers, France
| | - Arnaud W Thille
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.,Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| |
Collapse
|
6
|
Girault C, Gacouin A. [Tracheotomy and high-flow oxygen therapy for mechanical ventilation weaning]. Rev Mal Respir 2017; 34:465-476. [PMID: 28502365 DOI: 10.1016/j.rmr.2017.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Girault
- Service de réanimation médicale, hôpital Charles-Nicolle, groupe de recherche sur le handicap ventilatoire (GRHV), UPRES EA 3830-institut de recherche et d'innovation biomédicale (IRIB), faculté de médecine et de pharmacie, université de Rouen, centre hospitalier universitaire-hôpitaux de Rouen, 76031 Rouen cedex, France
| | - A Gacouin
- Inserm-CIC, service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, centre hospitalier universitaire de Rennes, 35043 Rennes, France.
| |
Collapse
|
7
|
Porhomayon J, El-Solh AA, Pourafkari L, Jaoude P, Nader ND. Applications of Nasal High-Flow Oxygen Therapy in Critically ill Adult Patients. Lung 2016; 194:705-14. [PMID: 27142658 DOI: 10.1007/s00408-016-9885-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/22/2016] [Indexed: 02/08/2023]
Abstract
The use of nasal high-flow oxygen therapy (NHFOT) has become increasingly common in hospitals across Europe, Asia, and North America. These high utility devices provide an efficient and comfortable access points for providing supplemental oxygen to patients with variety of respiratory disorders. They are relatively easy to set up, and clinicians and patients alike give very positive feedback about their ease of use and comfort for patients in the hospital setting. However, it remains uncertain whether NHFOT improves patient survival or even reduces respiratory complications. Outcome data in adult populations are few and frequently underpowered to guide physicians for their widespread use in hospital setting. In this article, we present a review of the current technology and available studies pertinent to NHFOT.
Collapse
Affiliation(s)
- Jahan Porhomayon
- VA Western New York Healthcare System, Division of Critical Care Medicine, Department of Anesthesiology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA. .,VA Medical Center, Rm 203C, 3495 Bailey Ave, Buffalo, NY, 14215, USA.
| | - Ali A El-Solh
- VA Western New York Healthcare System, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Leili Pourafkari
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | - Philippe Jaoude
- VA Western New York Healthcare System, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nader D Nader
- VA Western New York Healthcare System, Division of Cardiothoracic Anesthesia and Pain Medicine, Department of Anesthesiology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
8
|
Delaying intubation with high-flow nasal cannula therapy: a dilemma between the technique and clinical management! Intensive Care Med 2015; 41:1514-5. [PMID: 26077061 DOI: 10.1007/s00134-015-3863-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
|
9
|
Venot M, Kouatchet A, Jaber S, Demoule A, Azoulay É. Stratégies ventilatoires en situations palliatives. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
L’oxygénothérapie dans tous ces états ou comment administrer l’oxygène en 2014 ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
Chanques G, Jaber S. [Unexpected progress of an old intensive care therapy, oxygen: towards more comfort and less mechanical ventilation…]. Rev Mal Respir 2013; 30:605-8. [PMID: 24182647 DOI: 10.1016/j.rmr.2013.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/16/2013] [Indexed: 01/17/2023]
Affiliation(s)
- G Chanques
- Département d'anesthésie-réanimation, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Unité U1046, Institut national de la santé et de la recherche médicale (Inserm), université de Montpellier 1, université de Montpellier 2, 34295 Montpellier cedex 5, France.
| | | |
Collapse
|