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. 2023 Oct 18;13(1):104.
doi: 10.1186/s13613-023-01203-z.

Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study

Roque Basoalto  1   2   3 , L Felipe Damiani  3   4 , Yorschua Jalil  1   3   4 , María Consuelo Bachmann  1   3   5 , Vanessa Oviedo  1 , Leyla Alegría  1   6 , Emilio Daniel Valenzuela  1 , Maximiliano Rovegno  1 , Pablo Ruiz-Rudolph  7 , Rodrigo Cornejo  8   9 , Jaime Retamal  1   9 , Guillermo Bugedo  1 , Arnaud W Thille  10   11 , Alejandro Bruhn  12   13
Affiliations

Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study

Roque Basoalto et al. Ann Intensive Care. .

Abstract

Background: Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers.

Methods: This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers.

Results: We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2-7.1] vs. 7.2 [5.6-10.3] cmH2O; p < 0.001), pressure-time product (85 [67-140] vs. 156 [114-238] cmH2O*s/min; p < 0.001) and ΔEAdi (10 [7-13] vs. 14 [9-16] µV; p = 0.022). In addition, HFNC induced increases in end-expiratory lung volume and PaO2/FiO2 ratio, decreases in respiratory rate and ventilatory ratio, while no changes were observed in systemic hemodynamics, Troponin T, or in amino-terminal pro-B-type natriuretic peptide.

Conclusions: Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles. Trial registration January 15, 2021. NCT04711759.

Keywords: Esophageal pressure; Reintubation; Weaning; Work of breathing.

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Conflict of interest statement

A.W.T has received speaking honoraria from Fisher and Paykel Healthcare.

Figures

Fig. 1
Fig. 1
High-flow nasal cannula (HFNC) oxygen therapy applied after extubation decreases work of breathing and respiratory rate. HFNC reduces inspiratory esophageal pressure swings (A) and pressure–time product per minute (B) in comparison with standard oxygen This indicates a lower metabolic cost and respiratory effort associated with the use of HFNC. Horizontal red lines represent median values. P values were calculated using a two-way repeated measures ANOVA
Fig. 2
Fig. 2
High-flow nasal cannula (HFNC) oxygen therapy applied after extubation decreases respiratory rate (A), has no effect on tidal volume (B), it increases PaO2/FiO2 ratio (C), and it did not modify arterial carbon dioxide levels (D), compared to standard oxygen. Horizontal red lines represent mean values. P values were calculated using a two-way repeated measures ANOVA
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Comment in

References

    1. Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294–1302. doi: 10.1164/rccm.201208-1523CI. - DOI - PubMed
    1. Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med. 2013;188(2):220–230. doi: 10.1164/rccm.201212-2169OC. - DOI - PubMed
    1. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186–192. doi: 10.1378/chest.112.1.186. - DOI - PubMed
    1. Beduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning outcome according to a new definition. The WIND study. Am J Respir Crit Care Med. 2017;195(6):772–783. doi: 10.1164/rccm.201602-0320OC. - DOI - PubMed
    1. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014;190(3):282–8. doi: 10.1164/rccm.201402-0364OC. - DOI - PubMed

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