Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial
Cédric Carrié,
Benjamin Rieu,
Antoine Benard,
Kilian Trin,
Laurent Petit,
Alexandre Massri,
Igor Jurcison,
Guillaume Rousseau,
David Tran Van,
Marie Reynaud Salard,
Jeremy Bourenne,
Albrice Levrat,
Laurent Muller,
Damien Marie,
Claire Dahyot-Fizelier,
Julien Pottecher,
Jean-Stéphane David,
Thomas Godet,
Matthieu Biais
Affiliations
Cédric Carrié
Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital
Benjamin Rieu
Anesthesiology and Critical Care Department, Clermont – Ferrand University Hospital
Antoine Benard
Pôle de Santé Publique, Service d’information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux
Kilian Trin
Pôle de Santé Publique, Service d’information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux
Laurent Petit
Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital
Alexandre Massri
Anesthesiology and Critical Care Department, Pau Hospital
Igor Jurcison
Anesthesiology and Critical Care Department, Beaujon University Hospital
Guillaume Rousseau
Anesthesiology and Critical Care Department, Beaujon University Hospital
David Tran Van
Anesthesiology and Critical Care Department, Robert Picqué Hospital
Marie Reynaud Salard
Anesthesiology and Critical Care Department, Saint Etienne University Hospital
Jeremy Bourenne
Emergency and Critical Care Department, Hôpital de La Timone, Marseille University Hospital
Albrice Levrat
Anesthesiology and Critical Care Department, Annecy Hospital
Laurent Muller
Anesthesiology and Critical Care Department, Nimes University Hospital
Damien Marie
Anesthesiology and Critical Care Department, Poitiers University Hospital
Claire Dahyot-Fizelier
Anesthesiology and Critical Care Department, Poitiers University Hospital
Julien Pottecher
Anesthesiology and Critical Care Department, Strasbourg University Hospital
Jean-Stéphane David
Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL)
Thomas Godet
Anesthesiology and Critical Care Department, Clermont – Ferrand University Hospital
Matthieu Biais
Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital
Abstract Background The benefit–risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O2) during the early stage of blunt chest trauma remains controversial because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients. Methods The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO2/FiO2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O2 and “early” NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and “late” NIV, indicated in patients with respiratory deterioration and/or PaO2/FiO2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS). Results Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20–2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73–5.89], p = 0.18, 0.85 [95%IC: 0.33–2.20], p = 0.74 and 2.14 [95%IC: 0.36–20.77], p = 0.41, respectively). Conclusion A prompt association of HFNC-O2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure. Clinical Trial Registration: NCT03943914, Registered 7 May 2019.
