Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial

This research by Hernandez and colleagues was published in JAMA on 5th April 2016.  The abstract is described below and a physical copy of the issue is available in the Health Care library on Level D of the hospital.

Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking.

This multi-centre randomized clinical trial was conducted between September 2012 and October 2014 in 7 intensive care units (ICUs) in Spain. Participants were 527 adult critical patients at low risk for reintubation who fulfilled criteria for planned extubation.  Patients were randomized to undergo either high-flow or conventional oxygen therapy for 24 hours after extubation.

The primary outcome was reintubation within 72 hours, compared with the Cochran-Mantel-Haenszel χ2 test. Secondary outcomes included postextubation respiratory failure, respiratory infection, sepsis and multiorgan failure, ICU and hospital length of stay and mortality, adverse events, and time to reintubation.  Of the 527 patients randomised 264 received high-flow therapy and 263 conventional oxygen therapy.

Reintubation within 72 hours was less common in the high-flow group (4.9% vs 12.2%) in the conventional group.  Postextubation respiratory failure was less common in the high-flow group (8.3% vs 14.4%).  Time to reintubation was not significantly different between groups 19 hours in the high-flow group vs 15 hours in the conventional group. No adverse effects were reported.

Among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.

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