Predictors of HFNC Failure in Patients With AHRF Using Echocardiography Parameters

Right ventricular dysfunction (RVD) and right ventricular-pulmonary arterial (RV-PA) uncoupling detected by transthoracic echocardiography (TTE) in acute respiratory distress syndrome (ARDS) are associated with poor survival. Early detection of RVD and RV-PA uncoupling in patients with acute hypoxemic respiratory failure (AHRF) may be indicative of worsening and decompensating pulmonary condition which may require escalation of respiratory support. The use of TTE parameters in predicting high-flow nasal cannula (HFNC) failure has not been previously studied. The objective of this study is to identify predictors of HFNC failure by TTE and to compare its performance with the well-established ROX index.

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Key information

Conditions

Acute Hypoxemic Respiratory Failure Respiration Disorders Respiratory Insufficiency Respiratory Tract Diseases

Age range

18 year–100 year

Sex eligibility

All sexes

Study type

Observational

Primary location

Queen Mary Hospital

Hong Kong

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Age ≧ 18; AND
Acute hypoxemic respiratory failure (AHRF), defined by respiratory rate of greater than 25 breaths per minute and a ratio of the PaO2 to the fraction of inspired oxygen (PaO2 / FiO2) of less than 300, and use of accessory muscles of respiration or paradoxical abdominal motion; AND
Required ventilatory support with high-flow nasal cannula (HFNC)

Exclusion criteria

Patients suffering from hypercapnic respiratory failure; OR
AHRF secondary to conditions that are indicated for non-invasive ventilation (NIV) (e.g. acute exacerbation of COPD, cardiogenic pulmonary edema); OR
Use of NIV or invasive mechanical ventilation (IMV) prior to HFNC initiation; OR
Patients with imminent need for endotracheal intubation and invasive mechanical ventilation (IMV); OR
Patients with known or suspected diaphragm paralysis; OR
Pregnancy; OR
Patients with abdominal compartment syndrome; OR
Use of HFNC for more than 12 hours prior to ICU admission; OR
Patients with suboptimal echocardiographic image quality for data processing; OR

Treatment and study plan

Transthoracic echocardiography

Diagnostic Test

Transthoracic Echocardiography to look for evidence of right ventricular (RV) dysfunction and right ventricular-pulmonary arterial (RV-PA) uncoupling.

Primary outcomes

High-flow nasal cannula (HFNC) therapeutic failure

Time frame: From the start of recruitment into study (i.e. start of HFNC use), till the date of study endpoint (i.e., step up to non-invasive ventilation, intubation, death on HFNC, or weaned off HFNC, whichever came first), assessed up to 4 weeks.

Predictive value of transthoracic echocardiography (TTE) in detecting High-flow nasal cannula (HFNC) therapeutic failure in patients with acute hypoxemic respiratory failure (AHRF).

Sponsors and collaborators

Lead sponsor

Queen Mary Hospital, Hong Kong

Other

Registry information

Official study title

Predictors of High-Flow Nasal Cannula Failure (HFNC) in Patients With Acute Hypoxemic Respiratory Failure (AHRF) Using Echocardiography Parameters

Acronym: AHRF-ECHO

Important dates

Study start: 2023
Primary completion: 2024
Study completion: 2024
First posted: Oct 23, 2023
Registry last updated: Oct 16, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Published trials that share one or more normalized conditions with this study.

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