Comprehensive assessment of ventilator supports in Emergency Medicine ; Approche globale du support ventilatoire en médecine d'urgence

Acute respiratory failure is a common complaint of patients visiting the Emergency Department and conventional oxygen therapy is its first-line treatment. Ventilatory support is required when nasal oxygen therapy is not enough or as a first-line treatment in the most severe cases. Ventilatory supports include high-flow and humidified nasal cannula oxygen (HNFO) and mechanical ventilation. Data assessing their values in Emergency Departments (EDs) mainly come from research conducted in Intensive Care Units. In addition, a comprehensive approach of their application and their results in Emergency Departments has never been conducted.The aim of this research is to provide a comprehensive assessment of ventilatory supports in EDs by assessing the place of HFNO, introducing recently in this setting, and the practice of noninvasive and invasive mechanical ventilation in EDs. We assessed first the clinical and biological impact of HFNO in patients admitting to an ED for de novo acute hypoxemic respiratory failure, then in patients admitting for acute hypercapnic respiratory failure secondary to acute heart failure, through two prospective studies. In addition, we provided a matching of data issued from all prospective trials conducted in the EDs. We aimed to determine if early application of HFNO in patients with acute respiratory failure improves outcome. We found HFNO applied early was associated with an improvement in clinical and biological patterns in patients admitted for de novo acute hypoxemic respiratory failure, and similarly in patients admitted for acute hypercapnic respiratory failure due to acute heart failure. However, HFNO was not associated with a reduction of mechanical ventilation requirements or in mortality. In addition, we assessed mechanical ventilation in the ED by analysing three determinants that may influence patient’s outcome. First, we conducted a large bench test assessing performance and usability of all emergency ventilators marketed in Europe or North America and assessing through two ...