1. Original Article
High-Flow Oxygen through Nasal Cannula in Acute
Hypoxemic Respiratory Failure
Jean-Pierre Frat, M.D., Arnaud W. Thille, M.D., Ph.D., Alain Mercat, M.D., Ph.D.,
Christophe Girault, M.D., Ph.D., Stéphanie Ragot, Pharm.D., Ph.D., Sébastien
Perbet, M.D., Gwénael Prat, M.D., Thierry Boulain, M.D., Elise Morawiec, M.D., Alice
Cottereau, M.D., Jérôme Devaquet, M.D., Saad Nseir, M.D., Ph.D., Keyvan
Razazi, M.D., Jean-Paul Mira, M.D., Ph.D., Laurent Argaud, M.D., Ph.D., Jean-
Charles Chakarian, M.D., Jean-Damien Ricard, M.D., Ph.D., Xavier Wittebole, M.D.,
Stéphanie Chevalier, M.D., Alexandre Herbland, M.D., Muriel Fartoukh, M.D., Ph.D.,
Jean-Michel Constantin, M.D., Ph.D., Jean-Marie Tonnelier, M.D., Marc Pierrot, M.D.,
Armelle Mathonnet, M.D., Gaëtan Béduneau, M.D., Céline Delétage-Métreau, Ph.D.,
Jean-Christophe M. Richard, M.D., Ph.D., Laurent Brochard, M.D., René
Robert, M.D., Ph.D., for the FLORALI Study Group and the REVA Network
N Engl J Med
Volume 372(23):2185-2196
June 4, 2015
2. Study Overview
• Patients with acute hypoxemic respiratory failure were assigned to
standard oxygen therapy, high-flow oxygen therapy, or noninvasive
ventilation.
• The intubation rate did not differ significantly among the groups, but 90-
day mortality was lower in the high-flow–oxygen group.
4. Kaplan–Meier Plots of the Cumulative Incidence of Intubation from Randomization to Day 28.
Frat J-P et al. N Engl J Med 2015;372:2185-2196
5. Kaplan–Meier Plot of the Probability of Survival from Randomization to Day 90.
Frat J-P et al. N Engl J Med 2015;372:2185-2196
6. Characteristics of the Patients at Baseline, According to Study Group.
Frat J-P et al. N Engl J Med 2015;372:2185-2196
7. Primary and Secondary Outcomes, According to Study Group.
Frat J-P et al. N Engl J Med 2015;372:2185-
2196
8. Conclusions
• In patients with nonhypercapnic acute hypoxemic respiratory failure,
treatment with high-flow oxygen, standard oxygen, or noninvasive
ventilation did not result in significantly different intubation rates.
• There was a significant difference in favor of high-flow oxygen in 90-day
mortality.
Editor's Notes
#3: Figure 1 Enrollment, Randomization, and Follow-up of the Study Participants. High-flow oxygen indicates therapy with high-flow oxygen through a nasal cannula. Patients who were assigned to receive noninvasive positive-pressure ventilation (hereafter, noninvasive ventilation) received noninvasive ventilation and high-flow oxygen between sessions of noninvasive ventilation. Standard oxygen therapy was given through a nonrebreather face mask at a flow rate of 10 liters or more per minute. Patients may have had more than one reason for exclusion from the trial. Scores on the Glasgow Coma Scale range from 3 to 15, with lower scores indicating reduced levels of consciousness. ICU denotes intensive care unit, and PaCO2 partial pressure of arterial carbon dioxide.
#4: Figure 2 Kaplan–Meier Plots of the Cumulative Incidence of Intubation from Randomization to Day 28. Results in the overall population and in patients with a PaO2:FIO2 of 200 mm Hg or less are shown. PaO2:FIO2 denotes the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen.
#5: Figure 3 Kaplan–Meier Plot of the Probability of Survival from Randomization to Day 90.
#6: Table 1 Characteristics of the Patients at Baseline, According to Study Group.
#7: Table 2 Primary and Secondary Outcomes, According to Study Group.
