6/28/23, 11:44 PM OptiTHO Pathway Feedback Search Clinical Topics Home Studies OptiTHO OptiTHO Disease Blunt chest trauma Trial question What is the role of prophylactic noninvasive ventilation and high-flow nasal oxygen therapy in hypoxemic blunt chest trauma patients? Study design Multi-center Open label RCT Population Characteristics of study participants 15.0% female N = 141 85.0% male 141 patients (21 female, 120 male) Inclusion criteria: adult patients admitted to the ICU within 48 hours after high-risk blunt chest trauma, non-severe hypoxemia, and no evidence of acute respiratory failure Key exclusion criteria: need for emergency intubation; hypercapnia; previous surgical intervention by thoracotomy or laparotomy; contraindications for noninvasive ventilation; a do-not-intubate order Interventions N=71 early noninvasive ventilation and high-flow nasal oxygen therapy (a prompt association of high-flow nasal oxygen therapy and early non-invasive ventilation in every patient for at least 48 hours) https://web.pathway.md/studies/recmPAKJxAgPlMjNM 1/2 6/28/23, 11:44 PM OptiTHO Pathway N=70 late noninvasive ventilation and conventional oxygen therapy (conventional oxygen therapy and late noninvasive ventilation, indicated in patients with respiratory deterioration and/or ratio of arterial oxygen partial pressure to fractional inspired oxygen 200 mmHg) Primary outcome Endotracheal intubation for delayed respiratory failure 8.6 % 8.6 7 6.4 % 4.3 % 2.1 % No significant difference 0.0 % Early noninvasive ventilation and high-flow nasal oxygen therapy Late noninvasive ventilation and conventional oxygen therapy No significant difference in endotracheal intubation for delayed respiratory failure (7% vs. 8.6%; OR 0.72, 95% CI 0.2 to 2.43) Safety outcomes No significant difference in secondary pneumothorax or vomiting/aspiration. Significant difference in excessive agitation with need for sedatives or noninvasive ventilation removal (21% vs. 3%). Conclusion In adult patients admitted to the ICU within 48 hours after high-risk blunt chest trauma, non-severe hypoxemia, and no evidence of acute respiratory failure, early noninvasive ventilation and high-flow nasal oxygen therapy were not superior to late noninvasive ventilation and conventional oxygen therapy with respect to endotracheal intubation for delayed respiratory failure. Reference C dric Carri , Benjamin Rieu, Antoine Benard et al. Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial. Crit Care. 2023 Apr 26;27(1):163. Open reference URL https://web.pathway.md/studies/recmPAKJxAgPlMjNM 2/2