High flow conditioned oxygen therapy for prevention of reintubation in critically ill patients: a preliminary cohort study

Abstract

Objective: To determine the impact of delivering high flow conditioned oxygen therapy (HFO) through nasal cannula on prevention of reintubation in mechanically ventilated (MV) critically ill patients. Design: Prospective cohort sturdy. Setting: General ICU of a university hospital. Patients: all patients under MV > 12-h and after scheduled extubation. Exclusion criteria: hypercapnia at extubation, non-scheduled extubation or with do-not-resuscitate orders. Patients were also divided between low and high reintubation risk. Interventions: From September 2011 to September 2012, all patients received HFO after extubation for a fixed 24-h period and were compared with a historical cohort (2008-2011) treated with conventional oxygen therapy and matched for risk of reintubation. Measurements and Main Results: The primary endpoint was reintubation rate within the 72-h following extubation. Statistical analyses included logistic multivariate model. Main Results: Each cohort included 111 patients with similar clinical characteristics. The HFO group showed a non-significant lower reintubation rate (8.1% vs. 15.3%, p = 0.09). Variables independently related to reintubation rate in the multivariate analysis were HFO (OR 0.31 [0.10-0.95] p = 0.04), hypercapnia after extubation (OR 51.20 [11.55-226.63] p < 0.01), APACHE II > 12 at extubation (OR 1.06 [1.01-1.12] p = 0.04) and length of MV (OR 1.16 [1.03-1.30] p =0.01). The area under the ROC curve for the model was 0.89 (0.77- 0.94). Conclusions: Routine HFO after planned extubation appears to be associated with lower reintubation rate.