Weaning From High Flow Nasal Oxygen in Acute Respiratory Failure : a Target Trial Emulation

Weaning From High Flow Nasal Oxygen in Acute Respiratory Failure : a Target Trial Emulation From Nouvelle-Aquitaine Health Data Warehouses

Acute respiratory failure is a frequent reason for admission to the intensive care unit (ICU). It is associated with high healthcare consumption and mortality.

High-flow nasal oxygen (HFNO) improves comfort, reduces the risk of intubation and may reduce the risk of mortality in the most severe patients with acute hypoxemic respiratory failure compared with other oxygenation strategies. Therefore, HFNO is recommended as a first-line non-invasive oxygenation strategy in acute hypoxemic respiratory failure.

The timing of weaning patients from HFNO is complex. On the one hand, failure to wean from HFNO is associated with prolonged duration of HFNO and prolonged ICU stay. On the other hand, continued HFNO in patients ready to be weaned may unnecessarily prolong ICU stay and contribute to overwhelming of ICU capacities.

The overarching goal of this study is to identify the characteristics of patients in whom weaning from HFNO is not beneficial.

Inclusion Criteria:

• Adult patients (age > 18)
• Admitted to participating ICUs
• Treated with HFNO at the attending physician's discretion for acute respiratory failure (defined as respiratory rate ≥ 25 breaths/min)

Exclusion Criteria:

• Prophylactic HFNO to prevent reintubation after extubation
• Noninvasive ventilation before HFNO initiation