Clinical Effect of the Association of Noninvasive Ventilation and High Flow Nasal Oxygen Therapy in Resuscitation of Patients With Acute Lung Injury (FLORALI Study) (FLORALI)

• mechanical ventilation-free to day 28 [ Time Frame: 28 days ]
• ICU morbidity [ Time Frame: at day 28 ]

The aim of the study is to compare, in patients with acute respiratory failure/acute lung injury the efficacy of three different methods of oxygenation to prevent endotracheal intubation :

1. conventional oxygen therapy (O2 conventional)
2. high flow nasal oxygen therapy (O2-HFN)
3. association of high flow nasal oxygen therapy with non invasive positive pressure ventilation (O2-HFN/NPPV).

• Acute Lung Injury
• Acute Respiratory Failure

• Other: O2 conventional
  standard low flow therapy
• Device: O2-HFN : high flow nasal oxygen therapy
  The patient will receive high flow nasal of humidified oxygen, set between 30 to 50 l/min. The inspired fraction of oxygen (FiO2) will be adjusted in order to obtain a SpO2 >92%.
• Device: O2-HFN/NPPV : association of high flow nasal oxygen therapy and non invasive positive pressure ventilation
  The patient will receive successively in a day NPPV and O2-HFN. The NPPV will be applied with an airway humidification achieved by using a heated humidifier and a facial mask adapted to the morphology of the patient. The settings will be adjusted as follow : an inspiratory pressure between 6 to 14 cmH2O, in order to obtain a tidal volume between 7 to 10 ml/kg of predicted weight, a positive expiratory pressure between 0 to 10 cmH2O in order to obtain a SpO2 >92% with the minimal FiO2.

• Active Comparator: O2 conventional : standard low flow therapy
  in order to obtain a SpO2>92%
  Intervention: Other: O2 conventional
• Experimental: O2-HNF : high flow nasal oxygen therapy
  set between 30 to 50 l/min,adjusted in order to obtain a SpO2 >92%.
  Intervention: Device: O2-HFN : high flow nasal oxygen therapy
• Experimental: O2-HFN/NPPV
  cycling of NIV and O2-HDN
  Intervention: Device: O2-HFN/NPPV : association of high flow nasal oxygen therapy and non invasive positive pressure ventilation

Inclusion Criteria:

• Hypoxemic and no hypercapnic acute respiratory failure :
• severe dyspnea at rest with a respiratory rate >25 breaths/min
• PaO2/FiO2 <300
• PaCO2 <45 mmHg,

Exclusion Criteria:

• age <18 years
• NPPV contraindications
• past history of respiratory chronic disease (COPD, cystic fibrosis…)
• cardiac pulmonary edema
• Pre-defined intubation
• other than respiratory organ failure : systolic pressure <90 mmHg,current treatment with epinephrine or norepinephrine, decreased level of consciousness ( Glasgow score ≤ 12)
• profound aplasia (white cells count <1000/mm 3)