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. 2022 Oct;85(4):332-340.
doi: 10.4046/trd.2022.0040. Epub 2022 Jul 13.

Cardiac Dysfunction Is Not Associated with Increased Reintubation Rate in Patients Treated with Post-extubation High-Flow Nasal Cannula

Jae Kyeom Sim  1 , Juwhan Choi  1 , Jee Youn Oh  1 , Kyung Hoon Min  1 , Gyu Young Hur  1 , Sung Yong Lee  1 , Jae Jeong Shim  1 , Young Seok Lee  1
Affiliations

Cardiac Dysfunction Is Not Associated with Increased Reintubation Rate in Patients Treated with Post-extubation High-Flow Nasal Cannula

Jae Kyeom Sim et al. Tuberc Respir Dis (Seoul). 2022 Oct.

Abstract

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period.

Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation.

Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292).

Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

Keywords: Cardiac Dysfunction; Extubation; High-Flow Nasal Cannula; Reintubation.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flow chart of enrolled patients. ICU: intensive care unit; EMR: electronic medical record; SBT: spontaneous breathing trial; COT: conventional oxygen therapy; NIV: non-invasive ventilation; HFNC: high-flow nasal cannula; EF: ejection fraction.
Figure 2.
Figure 2.
Group comparison of changes in physiologic parameters within 12 hours after extubation. (A) Systolic blood pressure change within 12 hours after extubation. (B) Diastolic blood pressure change within 12 hours after extubation. (C) Heart rate change within 12 hours after extubation. (D) Respiratory rate change within 12 hours after extubation.
Figure 3.
Figure 3.
Group comparison of changes in high-flow nasal cannula settings within 12 hours after extubation. (A) FiO2 change within 12 hours after extubation. (B) Flow rate within 12 hours after extubation. FiO2: fraction of inspired oxygen.
Figure 4.
Figure 4.
Kaplan-Meier plots showing the cumulative rate of reintubation within 72 hours after extubation according to the presence of cardiac dysfunction.
See this image and copyright information in PMC

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