Weaning Protocol for High-flow Nasal Oxygen Therapy in Intensive Care

NCT ID: NCT06104956

Last Updated: 2025-07-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

370 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-17

Study Completion Date

2027-03-31

Brief Summary

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High-flow nasal oxygen therapy (HFNO) is an oxygenation technique frequently used in intensive care.

The main objective of our study is to show that the use of a protocol for weaning patients off high-flow nasal oxygen therapy (HFNO) in the intensive care unit increases the probability that patients will be weaned from HFNO at Day 7 post-randomisation.

This is a open-label multicentre randomised controlled trial conducted in two parallel groups.

The primary endpoint is the success rate at Day 7, with success defined as "definitive" weaning from HFNO, i.e. patients weaned from HFNO for more than 48 hours without recourse to non-invasive ventilation (NIV) or intubation and still alive at Day 7.

The weaning protocol will be started as soon as the patient meets all the inclusion criteria, considered to be the prerequisites for initiating weaning from HFNO. Patients will be monitored until Day 28 maximum.

Detailed Description

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Conditions

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Acute Hypoxemic Respiratory Failure High-flow Nasal Oxygen Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Experimental group : Imposed weaning protocol

The flow of the HFNO will remain high (50-60 L/min) guaranteeing the effectiveness of the HFNO on the wash-out of the anatomical space. At the same time, weaning will begin with a gradual reduction in FiO2 of 0.1 every 4 hours. To achieve this reduction, the patient will have to meet the safety targets of a stable respiratory rate at rest (no increase) and pulsed oxygen saturation (SpO2). The SpO2 target will be 92-95%. Once the FiO2 has stabilised at 0.4 for 4 hours, the nurse will initiate a 10 L/min reduction in the flow of HFNO every 4 hours. The oxygen therapy support may be changed for standard oxygen when the HFNO flow rate is 40L/min with an FIO2 of 0.4 for 4 consecutive hours.

Group Type EXPERIMENTAL

HFNO weaning protocol

Intervention Type DRUG

Algorithm based on SpO2 values and respiratory rate: a decrease of FiO2 and of the flow will be done

Control group

Weaning methods will be left to the free choice of the practitioner. Any change in the HFNO setting must be made on medical prescription. A minimum SpO2 objective is required (SpO2 ≥92%).

Group Type ACTIVE_COMPARATOR

HFNO Standard of care

Intervention Type DRUG

Weaning methods will be left to the free choice of the practitioner.

Interventions

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HFNO weaning protocol

Algorithm based on SpO2 values and respiratory rate: a decrease of FiO2 and of the flow will be done

Intervention Type DRUG

HFNO Standard of care

Weaning methods will be left to the free choice of the practitioner.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Major patient admitted to the intensive care unit or continuous care unit for de novo hypoxaemic acute respiratory failure (with a PaO2/FiO2 ratio \<300 mmHg)
* Treated with HDNO for at least 24 hours in an intensive care unit or continuous care unit
* Treated with HFNO with a flow rate ≥ 50L/min and inspired oxygen fraction (FiO2) ≥ 0.5, at inclusion
* With a ROX index (SpO2/FiO2/Respiratory Rate) stable or improving in the 6 hours prior to inclusion and greater than 4.88 (the patient must not be in a worsening phase).
* Had a blood gas test under HFNO within 24 hours of inclusion
* Participant covered by or entitled to social security
* Informed consent signed by the patient or its relatives if the patient is incapable; this consent must then be confirmed by the patient as soon as possible

Exclusion Criteria

* Presence of a patient included in the study and not weaned off HFNO in the sector managed by the nurse of the patient assessed for eligibility
* Concomitant non-invasive ventilation treatment
* Use of HFNO within 7 days of extubation
* Chronic obstructive pulmonary disease (Gold grade 3 or 4)
* Cardiogenic acute pulmonary oedema as the main cause of acute respiratory failure
* Diffuse interstitial lung disease as a medical history
* Patient with long-term non-invasive ventilation with external positive pressure
* Patient on long-term oxygen therapy at home
* Pregnant women, women in labour and breastfeeding mothers
* Persons deprived of their liberty by a judicial or administrative decision, persons hospitalised without consent and persons admitted to a health or social establishment for purposes other than research.
* Minor
* Adult subject to a legal protection measure (guardianship, curators, person under court protection)
* Patient with a medical decision not to intubate
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Tours

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mai-Anh NAY, MD

Role: PRINCIPAL_INVESTIGATOR

CHRU Orléans

Locations

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Intensive care, University Hospital, Blois

Blois, , France

Site Status RECRUITING

Intensive care unit, University Hospital, Bourg-en-Bresse

Bourg-en-Bresse, , France

Site Status RECRUITING

Intensive care, University Hospital, Bourges

Bourges, , France

Site Status RECRUITING

Intensive care unit, University Hospital, Caen

Caen, , France

Site Status NOT_YET_RECRUITING

Intensive care, University Hospital, Chartres

Chartres, , France

Site Status RECRUITING

Intensive care, University Hospital, Cholet

Cholet, , France

Site Status RECRUITING

Intensive care, University Hospital, Dax

Dax, , France

Site Status RECRUITING

Intensive care, University Hospital, Le Mans,

Le Mans, , France

Site Status RECRUITING

Intensive care, University Hospital, Orléans

Orléans, , France

Site Status RECRUITING

Intensive care, University Hospital, Tours

Tours, , France

Site Status RECRUITING

Intensive care unit, University Hospital, Vannes

Vannes, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Mai-Anh NAY, MD

Role: CONTACT

02.38.51.44.46 ext. +33

Marie LECLERC

Role: CONTACT

02.47.47.46.64 ext. +33

Facility Contacts

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Julien GROUILLE, MD

Role: primary

Salman Mohammad

Role: primary

Anna BOURREAU, MD

Role: primary

Pierrick BAUDUIN

Role: primary

0662885851

Juliette AUDIBERT, MD

Role: primary

Fabien JAROUSSEAU, MD

Role: primary

Adrien AUVET, MD

Role: primary

Mickael LANDAIS, MD

Role: primary

Mai-Anh NAY, MD

Role: primary

Sophie JACQUIER, MD

Role: primary

Agathe DELBOVE, MD

Role: primary

Other Identifiers

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DR230001

Identifier Type: -

Identifier Source: org_study_id

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