Background Use of a high-flow nasal cannula (HFNC) reduced postextubation respiratory failure (PERF) and reintubation rate compared to use of a low-flow oxygen system (LFOS) in low-risk patients. However, no obvious conclusion was reached for high-risk patients. Here, we sought to present the current status of HFNC use as adjunctive oxygen therapy in a clinical setting and to elucidate the nature of the protective effect following extubation.
Methods The medical records of 855 patients who were admitted to the intensive care unit of single university hospital during a period of 5.5 years were analyzed retrospectively, with only 118 patients ultimately included in the present research. The baseline characteristics of these patients and the occurrence of PERF and reintubation along with physiologic changes were analyzed.
Results Eighty-four patients underwent HFNC, and the remaining 34 patients underwent conventional LFOS after extubation. Physicians preferred HFNC to LFOS in the face of highrisk features including old age, neurologic disease, moderate to severe chronic obstructive pulmonary disease, a long duration of mechanical ventilation, low baseline arterial partial pressure of oxygen to fraction of inspired oxygen ratio, and a high baseline alveolar–arterial oxygen difference. The reintubation rate at 72 hours after extubation was not different (9.5% vs. 8.8%; P=1.000). Hypoxic respiratory failure was slightly higher in the nonreintubation group than in the reintubation group (31.9% vs. 6.7%; P=0.058). Regarding physiologic effects, heart rate was only stabilized after 24 hours of extubation in the HFNC group.
Conclusions No difference was found in the occurrence of PERF and reintubation between both groups. It is worth noting that similar PERF and reintubation ratios were shown in the HFNC group in those with certain exacerbating risk factors versus not. Caution is needed regarding delayed reintubation in the HFNC group.
Citations
Citations to this article as recorded by
Predictors and outcomes of high-flow nasal cannula failure following
extubation: A multicentre observational study Amit Kansal, Shekhar Dhanvijay, Andrew Li, Jason Phua, Matthew Edward Cove, Wei Jun Dan Ong, Ser Hon Puah, Vicky Ng, Qiao Li Tan, Julipie Sumampong Manalansan, Michael Sharey Nocon Zamora, Michael Camba Vidanes, Juliet Tolentino Sahagun, Juvel Taculod, Ad Annals of the Academy of Medicine, Singapore.2021; 50(6): 467. CrossRef
Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao Complexity.2021; 2021: 1. CrossRef