Harvard Catalyst Profiles

Acute hypoxemic respiratory failure is a common and deadly component of critical illness in low income countries (LICs). Even before the COVID-19 pandemic, the burden of hypoxemic critical illness in LICs was enormous, with pneumonia being the leading infectious cause of death worldwide, and hypoxemia causing additional mortality in other infections including malaria, tuberculosis, and resuscitated sepsis, as well as non-communicable diseases such as heart failure, asthma/COPD, cancer, and trauma. High flow oxygen therapy (HFO) is a system of delivering mixed humidified and heated oxygen and ambient air at flow rates up to 60 liters per minute through a large nasal cannula. HFO has been shown to reduce the need for intubation and in some cases reduce mortality, in adults with acute hypoxemic respiratory failure in high income countries (HICs). In LICs, the potential for mortality benefit from HFO may be greater because safe mechanical ventilation is largely unavailable. The goals of BREATHE are to quantify mortality impact and define implementation factors for HFO for adults with hypoxemia of any cause in LIC settings. A student on this project will be based at two sites in Rwanda, with trips to two sites in Kenya and one site in Malawi. The student will be integrally involved in all aspects of study design, team development, study staff training, patient enrolment, writing, and analysis. The student will facilitate all aspects of trial implementation at the sites, and may choose a sub-study area to primarily lead if desired. The student will learn about clinical trial implementation in resource variable settings.