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The aim of this study is to determine whether High Flow nasal cannula (HFNC) oxygen is more efficient than the standard High Flow face mask (HFFM) for preoxygenation before orotracheal intubation after crash induction in non severely hypoxemic patients
This study will be designed as followed : patients will be randomized in 2 groups : High Flow nasal cannula "HFNC" or standard High Flow face mask "HFFM".
Patients randomized in "HFNC" group will receive a four minutes preoxygenation period with Nasal High Flow Therapy (60 L/mn , fraction of inspired oxygen (FI02) = 100%) before orotracheal intubation under laryngoscopy after crash induction. After induction and during laryngoscopy, HFNC will be maintained in an attempt to achieve apneic oxygenation.
Patients randomized in "HFFM" group will received a four minutes preoxygenation period with standard face mask (15 L/mn) before orotracheal intubation under laryngoscopy after crash induction. After induction, HFFM will be removed, enabling laryngoscopic vision
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| High Flow nasal cannula oxygen (HFNC) | Experimental | Patients randomized in "HFNC" group will received a four minutes preoxygenation period with Nasal High Flow Therapy (HFT) Optiflow ®/Airvo® (60 l/mn FIO2 = 1) before orotracheal intubation under laryngoscopy after crash induction. |
|
| STANDARD high flow Face Mask (HFFM) | Active Comparator | Patients randomized in "Standard face mask" group will received a four minutes preoxygenation period with a standard face mask (15 l/mn) before orotracheal intubation under laryngoscopy after crash induction. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| OPTIFLOW/ AIRVO | Device | Patients randomized in "HFNC" group will received a four minutes preoxygenation period with Nasal High Flow Therapy (HFT) Optiflow ®/AIRVO® (60 l/mn FIO2 = 1) before orotracheal intubation under laryngoscopy after crash induction. |
| Measure | Description | Time Frame |
|---|---|---|
| lowest pulse oxymetry (SpO2) during intubation | This outcome will be assessed from the beginning of the endotracheal intubation procedure (immediately after induction) to the end of orotracheal intubation (airway catheterization) by monitoring the pulse oxymetry | From the beginning of the endotracheal intubation procedure (beginning of laryngoscopy, immediately after induction) to completed orotracheal intubation (airway catheterization). Usual duration is inferior to 10 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Pulse oximetry | from the beginning of preoxygenation period to the end of intubation procedure. Usual duration is inferior to 15 minutes | |
| number of desaturation events (under 80%) | From the beginning of the endotracheal intubation procedure (beginning of laryngoscopy, immediately after induction) to completed orotracheal intubation (airway catheterization). Usual duration is inferior to 10 minutes) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Olivier ZAMBON, MD | Nantes University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brest hospital, CHU La cavale Blanche, medical intensive care unit | Brest | 29609 | France | |||
| CHD LES OUDOUAIRIES Service de réanimation polyvalente |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30666367 | Derived | Guitton C, Ehrmann S, Volteau C, Colin G, Maamar A, Jean-Michel V, Mahe PJ, Landais M, Brule N, Bretonniere C, Zambon O, Vourc'h M. Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient: a randomized clinical trial. Intensive Care Med. 2019 Apr;45(4):447-458. doi: 10.1007/s00134-019-05529-w. Epub 2019 Jan 21. |
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| STANDARD Face Mask | Procedure | Patients randomized in "STANDARD Face Mask" group will received a four minutes preoxygenation period with a standard face mask (15 l/mn) before orotracheal intubation under laryngoscopy after crash induction. |
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| Reduction in morbi-mortality during the Intensive care Unit stay | from beginning of the preoxygenation period to discharged from intensive care unit (until day 28 for more) |
| SOFA score | Each day during the 5 first days after randomisation |
| La Roche-sur-Yon |
| 85925 |
| France |
| Ch Le Mans | Le Mans | 72033 | France |
| Nantes university hospital, hôtel Dieu, Anesthesia intensive care unit | Nantes | 44093 | France |
| Nantes University Hospital, Hôtel Dieu, Medical intensive care unit | Nantes | 44093 | France |
| Rennes university hospital, Hôpital Pontchaillou, medical intensive care unit | Rennes | 35033 | France |
| Nantes University hospital, Hôpital Laennec, pneumology intensive care unit | Saint-Herblain | 44800 | France |
| Tours university hospital, hôpital Bretonneau, medical intensive care unit | Tours | 37044 | France |