Acute Hypoxemic Respiratory Failure Clinical Trial
Official title:
Impact of Current Volume Under High-rate Nasal Oxygen Therapy During Acute Hypoxemic Respiratory Failure de Novo
De novo acute hypoxemic respiratory failure (AHRF) is associated with high overall mortality,
which increases significantly with the use of orotracheal intubation. High flow nasal canula
(HFNC) has turned to be the first line non-invasive oxygenation strategy aiming to avoid
intubation. One of the main factors worsening lung injury and increasing mortality in
invasively ventilated patients is a too high tidal volume (TV) delivered by the ventilator.
Consistent data suggest that such an aggravation of respiratory lesions may occur during
spontaneous ventilation if TV is too large. This phenomenon is called Patient self-inflicted
lung injury (P-SILI). The effect of TV on the outcome of patients with de novo AHRF under
HFNC has never been evaluated since TV is not easily accessible in patients under HFNC.
Investigators hypothesized that a large TV during HFNC has an impact on the outcome. TV will
be measured using chest Electrical Impedance Tomography (EIT). To calibrate the EIT data,
i.e. to be able to convert changes in thoracic impedance into TV, thoracic impedance signal,
flow and volume will be collected during a 4 cmH2O continuous positive airway pressure (CPAP)
test, using a pneumotachograph inserted on the ventilator circuit between the mask and the
Y-piece. Such a level of CPAP is supposed to reproduce the majority of the physiological
effects of HFNC. Thus, EIT signal can be used to calculate TV during HFNC since it remains
reliable even when the positive expiratory pressure changes.
A secondary objective is to quantify a respiratory distress index. This quantification will
be recorded by respiratory inductance plethysmography (RIP), obtained using two elastic bands
equipped with a sensor sensitive to their stretching, one positioned at the level of the
thorax, the other at the level of the abdomen. The stretching changes of the two bands during
the respiratory cycle allow evaluating their possible asynchronism by calculating the phase
angle Investigators want to be able to evaluate up to 6 predictors of HFNC failure in this
research with an effect size of 0.15, α risk of 0.05, and a power of 0.8. A number of 55
participants is required. Investigators plan to include 60 patients due to potential
withdrawal of consent and/or unusable data.
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