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

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

Julie Helms  1   2 , Pierre Catoire  3 , Laure Abensur Vuillaume  4 , Héloise Bannelier  5 , Delphine Douillet  6   7 , Claire Dupuis  8   9 , Laura Federici  10 , Melissa Jezequel  11 , Mathieu Jozwiak  12   13 , Khaldoun Kuteifan  14 , Guylaine Labro  14 , Gwendoline Latournerie  15   16 , Fabrice Michelet  17 , Xavier Monnet  18 , Romain Persichini  19 , Fabien Polge  20 , Dominique Savary  21   22 , Amélie Vromant  23 , Imane Adda  24   25 , Sami Hraiech  26   27
Affiliations

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

Julie Helms et al. Ann Intensive Care. .

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.

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Conflict of interest statement

JH: Honoraria for lectures from Asahi Kasei, Diagnostica Stago, Inotrem, MSD, Octapharma, Pfizer PFE France, Sanofi Aventis France, Shionogi; PC: no competing interest; LAV: no competing interest; HB: no competing interest; DD: no competing interest; CD: no competing interest; LF: no competing interest; MeJ: no competing interest; MJ: no competing interest; KK: no competing interest; GuL: no competing interest; GL: no competing interest; FM: no competing interest; XM: Getinge: consulting, member of the medical advisory board, lectures- Baxter healthcare: consulting, lectures—AOP health: lectures; RP: no competing interest; FP: no competing interest; DS: no competing interest; AV: no competing interest; IA: no competing interest; SH: MSD, Pfizer: support for attending scientific congresses.

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