HFNC vs BiPAP Flashcards
What is the design of the Frat et al 2015 (“FLORALI”) trial?
prospective RCT across 23 ICUS in France and Belgium investigating HFNC vs BIPAP vs NRB
what are the inclusion and exclusion criteria for the Frat et al 2015 (“FLORALI”) trial
inclusion: ALL 4 of RR > 25, PF < 300, NO HYPERCAPNEIA (>45), known underlying chronic resp failure,
exclusion: pco2 > 45, asthma or copd, pul edema, severe neutropenia, hemodynamic instability, pressor use, GCS < 12
describe what being in NIPPV group for the the Frat et al 2015 (“FLORALI”) trial was
being on NIPPV for at least 8 hours per day for 2 consecutive days w/ HFNC breaks
what were the main outcomes of the the Frat et al 2015 (“FLORALI”) trial
proportion of patients who required endotracheal intubation within 28 days. Prespecified intubation criteria:
- hemodynamic instability, neuro status deterioration, or 2 or more of the following: RR >40, lack of improvement in respiratory muscle workload, development of copious secretions, acidosis < 7.35, SpO2 < 90 for > 5 minutes, or “poor response.”
what was the most common reason for respiratory failure in the the Frat et al 2015 (“FLORALI”) trial? average BMI?
pneumonia ~ 75-80%. bMI average was 25
what did the Frat et al 2015 (“FLORALI”) trial show in terms of primary and secondary outcomes?
primary - there was no difference in the PROPORTION of patients intubated at day 28 w/ HFNC vs either bipap or nrb but the trend was towards HFNC (38 vs 50 vs 47% respectively)
secondary
- all cause mortality in the ICU - MORTALITY BENEFIT vs NIPPV (OR 2.55) but not NRB
- all cause mortality at 90 days - MORTALITY BENEFIT vs NIPPV (OR 2.5) but not NRB
- number of ventilator free days - 24 VS 19 VS 22 respectively, significant
in the Frat et al 2015 (“FLORALI”) trial HFNC and NRB groups were allowed to rescue with NIPPV prior to intubation. what percentage were eventually intubated?
70%
