Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference

Julie Helms; Pierre Catoire; Laure Abensur Vuillaume; Héloise Bannelier; Delphine Douillet; Claire Dupuis; Laura Federici; Melissa Jezequel; Mathieu Jozwiak; Khaldoun Kuteifan; Guylaine Labro; Gwendoline Latournerie; Fabrice Michelet; Xavier Monnet; Romain Persichini; Fabien Polge; Dominique Savary; Amélie Vromant; Imane Adda; Sami Hraiech

doi:10.1186/s13613-024-01367-2

Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference

Ann Intensive Care. 2024 Sep 5;14(1):140. doi: 10.1186/s13613-024-01367-2.

Authors

Julie Helms^{1

2}, Pierre Catoire³, Laure Abensur Vuillaume⁴, Héloise Bannelier⁵, Delphine Douillet^{6

7}, Claire Dupuis^{8

9}, Laura Federici¹⁰, Melissa Jezequel¹¹, Mathieu Jozwiak^{12

13}, Khaldoun Kuteifan¹⁴, Guylaine Labro¹⁴, Gwendoline Latournerie^{15

16}, Fabrice Michelet¹⁷, Xavier Monnet¹⁸, Romain Persichini¹⁹, Fabien Polge²⁰, Dominique Savary^{21

22}, Amélie Vromant²³, Imane Adda^{24

25}, Sami Hraiech^{26

27}

Affiliations

¹ Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France. Julie.helms@chru-strasbourg.fr.
² UMR 1260, Regenerative Nanomedicine (RNM), FMTS, INSERM (French National Institute of Health and Medical Research), Strasbourg, France. Julie.helms@chru-strasbourg.fr.
³ Emergency Medicine Department, University Hospital of Bordeaux, 1 Place Amélie Raba Léon, 33000, Bordeaux, France.
⁴ SAMU57, Service d'Accueil des Urgences, Centre Hospitalier Régional Metz-Thionville, 57530, Ars-Laquenexy, France.
⁵ Service d'Accueil des Urgences - SMUR Hôpital Pitié Salpêtrière Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
⁶ Department of Emergency Medicine, University Hospital of Angers, Angers, France.
⁷ UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France.
⁸ CHU Clermont-Ferrand, Service de Réanimation Médicale, Clermont-Ferrand, France.
⁹ Unité de Nutrition Humaine, Université Clermont Auvergne, INRAe, CRNH Auvergne, 63000, Clermont-Ferrand, France.
¹⁰ Service d'Anesthésie Réanimation, Centre Hospitalier D'Ajaccio, Ajaccio, France.
¹¹ Unité de Soins Intensifs Cardiologiques, Hôpital de Saint Brieuc, Saint-Brieuc, France.
¹² Service de Médecine Intensive Réanimation, CHU de Nice, 151 Route Saint Antoine de Ginestière, 06200, Nice, France.
¹³ UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
¹⁴ Service de Réanimation Médicale GHRMSA, 68100, Mulhouse, France.
¹⁵ Pole de Médecine d'Urgence- CHU Toulouse, Toulouse, France.
¹⁶ Université Toulouse III Paul Sabatier, Toulouse, France.
¹⁷ Service de Réanimation, Hôpital de Saint Brieuc, Saint-Brieuc, France.
¹⁸ AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
¹⁹ Service de Réanimation et Soins Continus, CH de Saintes, Saintes, France.
²⁰ Hôpitaux Universitaires de Paris Centre Site Cochin APHP, Paris, France.
²¹ Département de Médecine d'Urgences, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
²² IRSET Institut de Recherche en Santé, Environnement et Travail/Inserm EHESP - UMR_S1085, CAPTV CDC, 49000, Angers, France.
²³ Service d'Accueil des Urgences, Hôpital La Pitié Salpetrière, Paris, France.
²⁴ Department of Research, One Clinic, Paris, France.
²⁵ PointGyn, Paris, France.
²⁶ Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
²⁷ Faculté de Médecine, Centre d'Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.

Abstract

Introduction: Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023.

Methods: A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations.

Results: The jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made?

Conclusion: These recommendations should optimize the use of oxygen during ARF.

Keywords: Acute respiratory distress; Acute respiratory failure; Conference consensus; Guidelines; Oxygen therapy.