Thresholds for invasive ventilation in hypoxemic respiratory failure

The first study in this research program will be a prospective observational study called Assessing Equity, Rationale, and Outcomes in invasive and Non-invasive Oxygen Therapy (AERONOT).

Acute hypoxemic respiratory failure (AHRF) is a significant cause of death in patients in intensive care units. Those that survive their hospitalization face substantial morbidity, including ICU-acquired weakness, cognitive impairment, and mood disorders including depression and post-traumatic stress disorder. Evidence has shown that the burden of AHRF mortality and morbidity falls disproportionately on marginalized populations.

Intubation and invasive ventilation are important life-saving strategies when adequate oxygen levels cannot be achieved using non-invasive oxygen strategies, but these can also cause harm. Evidence for the timing of this critical decision is lacking; research has shown that intubation criteria used in RCTs do not mirror clinical practice and use of invasive ventilation varies across time and health care systems. The proposed structured, multi-phase program of research will bring evidence to guide decisions about when to intubate patients with AHRF. Developing objective criteria will support better patient outcomes and more equitable use of this type of intervention.