Please select the eligibility criteria that correspond to the clinical trial below.
Title: Acute Respiratory Failure After Cardio Thoracic Surgery: Non Invasive Ventilation (VNI) by BIPAP Vision Versus OPTIFLOW System, Comparison.
Brief Summary: The OPTIFLOW ™ use is becoming more common in acute respiratory failure cases, but its place in relation to VNI (Bi-PAP mode) is not yet defined. OPTIFLOW ™ vs the VNI comparison of the use, in the immediate postoperative period, should lead to define the role of each technique and lead to a optimal rationalization of patients management with acute respiratory failure after surgery.


Options:
A: Inclusion Criteria:

* Known immunosuppression defined as one or more of the following: (a) immunosuppressive drug or long-term \[\>3 months\] or high-dose \[\>0.5 mg/kg/day\] steroids; (b) solid organ transplantation; (c) solid tumour; (d) haematological malignancy.
* ICU admission for any reason
* Need for oxygen therapy ≥6 Liters/min defined as one or more of the following: (a) respiratory distress with a respiratory rate \>30/min; (b) cyanosis; (c) laboured breathing; (d) SpO2\<90%; and (e) expected respiratory deterioration during a procedure
* Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency.

Exclusion Criteria:

* Patient admitted to the ICU for end-of-life care. Do-not-intubate (DNI) patients can be included.
* Refusal of study participation or to pursue the study by the patient
* Hypercapnia with a formal indication for NIV \[PaCO2 ≥ 50 mmHg, formal indication for NIV\]
* Isolated cardiogenic pulmonary oedema \[formal indication for NIV\]. Patients with pulmonary oedema associated with another ARF etiology can be included.
* Pregnancy or breastfeeding
* Anatomical factors precluding the use of a nasal cannula
* Absence of coverage by the French statutory healthcare insurance system
* Post surgical setting from D1 to D6

After discussion at the investigator meeting and based on comments from the Data and Safety Monitoring Board on May 12, 2016, as all included patients need to have an acute hypoxemic respiratory failure and at least 6l of oxygen per minute, patients admitted to the ICU to secure any procedure (bronchoscopy etc..) or those not admitted for acute respiratory failure and who undergo intubation, will NOT be included in this trial. Only patients meeting criteria of acute respiratory failure will be included in this trial.
B: Inclusion Criteria:

* Patients after cardiac/thoracic surgery with acute respiratory failure defined by the presence of the following criteria:

  * report PaO2/FiO2 \<300
  * Respiratory rate\> 25 for at least 2 hours
  * Getting involved accessory respiratory muscles
  * paradoxical breathing Or
* In immediate after extubation, the patient will be eligible if present in the withdrawal test:

  * SaO2 \<90% in 12 L of O2 during a trial of spontaneous ventilation tube on
  * PaO2 \<10 kPa at a FiO2 ≥ 50% during a VS trial + pressure support
  * The presence of a risk factor: Obesity (BMI\> 30), FEVG \<40%, Failed extubation prior, stridor

Exclusion Criteria:

* Previous history of SAS
* Patient tracheotomy
* Comas non hypercapnic
* bradypnea
* Cardiac arrest
* Gastric Surgery recent
* Restlessness, lack of cooperation
* Nausea, vomiting
* Hemodynamic instability
C: Inclusion Criteria:

* Age \>20 years
* Subjective dyspnea in room air
* SaO2\< 90% in room air
* Oxygen requirement for nasal cannula \< 6 L/m

Exclusion Criteria:

* Unstable vital signs

  * SBP \<90 mmHg
  * DBP \< 60 mmHg
  * Heart rate \> 120 bpm
  * Respiratory rate \> 30 bpm
  * Persistent dyspnea under oxygen therapy using NC
* Severe hypoxia

  * PaO2/FiO2\< 200 mmHg
* Unable to cooperate

  * Delirium
  * Reduced cognitive function
D: Inclusion Criteria:

* Low Risk Patients:
* Any extubated patients after tolerating a spontaneous breathing trial.
* High Risk Patients:
* Any extubated patients after \>48 hours under mechanical ventilation and any of the following:
* \>65 years

  * cardiac failure as the primary indication of mechanical ventilation
  * COPD
  * APACHE II \>12 points the extubation day
  * BMI \>30
  * inability to manage respiratory secretions

    * 1 failed spontaneous breathing trial
    * 1 comorbidity
    * 7 days under mechanical ventilation

Exclusion Criteria:

* \<18 years
* thacheotomized patients
* recent facial or cervical trauma/surgery
* active gastro-intestinal bleeding
* lack of cooperation and patients with any failed spontaneous breathing trial because of hypercapnia development.

Answer: B