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. 2017 Dec;7(1):47.
doi: 10.1186/s13613-017-0270-9. Epub 2017 May 2.

High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial

Rafael Fernandez  1 , Carles Subira  2 , Fernando Frutos-Vivar  3 , Gemma Rialp  4 , Cesar Laborda  5 , Joan Ramon Masclans  6 , Amanda Lesmes  3 , Luna Panadero  3 , Gonzalo Hernandez  7
Affiliations

High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial

Rafael Fernandez et al. Ann Intensive Care. 2017 Dec.

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. Registered at Clinicaltrials.gov NCT01820507.

Keywords: High-flow oxygen; Mechanical ventilation; Reintubation; Weaning.

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Figures

Fig. 1
Fig. 1
CONSORT flowchart of the study
Fig. 2
Fig. 2
Kaplan–Meier plot of 72-h postextubation failure in patients receiving HFNC versus conventional oxygen therapy. The difference did not reach statistical significance (p = 0.2)
See this image and copyright information in PMC

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