High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial
Author
Fernandez, Rafael
Subirà Cuyàs, Carles
Frutos‑Vivar, Fernando
Rialp, Gemma
Laborda, Cesar
Masclans, Joan Ramon
Lesmes, Amanda
Panadero, Luna
Hernandez, Gonzalo
Publication date
2017-05-02ISSN
2110-5820
Abstract
Background: Extubation failure is associated with increased morbidity and mortality, but cannot be safely predicted or avoided. High-flow nasal cannula (HFNC) prevents postextubation respiratory failure in low-risk patients. Objective: To demonstrate that HFNC reduces postextubation respiratory failure in high-risk non-hypercapnic patients compared with conventional oxygen. Methods: Randomized, controlled multicenter trial in patients who passed a spontaneous breathing trial. We enrolled patients meeting criteria for high-risk of failure to randomly receive HFNC or conventional oxygen for 24 h after extubation. Primary outcome was respiratory failure within 72-h postextubation. Secondary outcomes were reintubation, intensive care unit (ICU) and hospital lengths of stay, and mortality. Statistical analysis included multiple logistic regression models. Results: The study was stopped due to low recruitment after 155 patients were enrolled (78 received high-flow and 77 received conventional oxygen). Groups were similar at enrollment, and all patients tolerated 24-h HFNC. Postextubation respiratory failure developed in 16 (20%) HFNC patients and in 21 (27%) conventional patients [OR 0.69 (0.31–1.54), p = 0.2]. Reintubation was needed in 9 (11%) HFNC patients and in 12 (16%) conventional patients [OR 0.71 (0.25–1.95), p = 0.5]. No difference was found in ICU or hospital length of stay, or mortality. Logistic regression models suggested HFNC [OR 0.43 (0.18–0.99), p = 0.04] and cancer [OR 2.87 (1.04–7.91), p = 0.04] may be independently associated with postextubation respiratory failure. Conclusion: Our study is inconclusive as to a potential benefit of HFNC over conventional oxygen to prevent occurrence of respiratory failure in non-hypercapnic patients at high risk for extubation failure.
Document Type
Article
Document version
Accepted version
Language
English
Subject (CDU)
61 - Medical sciences
Keywords
Nodrissons--Deslletament
Respiració artificial
Tràquea--Intubació
Oxigen
Neonatos--Alimentación
Respiración artificial
Tráquea -- Intubación
Oxígeno
Mechanical ventilation (Therapy)
Weaning
Intubation
Oxygen
Pages
7
Publisher
Springer Nature
Collection
7;
Is part of
Annals of Intensive Care
Citation
Fernandez, Rafael; Subira, Carles; Frutos‑Vivar, Fernando [et al.]. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Annals of Intensive Care, 2017, vol. 7, p. 1-7. Disponible en: <https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0270-9#article-info>. Fecha de acceso: 2 ene. 2020. DOI: 10.1186/s13613-017-0270-9.
This item appears in the following Collection(s)
- Ciències de la Salut [740]
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