Comparison of Postextubation Outcomes Associated with High - Flow Nasal Cannula vs. Conventional Oxygen Therapy in Patients at High Risk of Reintubation: a Randomized Clinical Trial

被引：14
作者：
Cho, Jun Yeun [1 ]
Kim, Hee-Sung [1 ]
Kang, Hyeran [1 ]
Kim, Sun-Hyung [1 ]
Choe, Kang Hyeon [1 ]
Lee, Ki Man [1 ]
Shin, Yoon Mi [1 ]
机构：
[1] Chungbuk Natl Univ, Chungbuk Natl Univ Hosp, Dept Internal Med, Coll Med, 776,1Sunhwan Ro, Cheongju 28644, South Korea
来源：
JOURNAL OF KOREAN MEDICAL SCIENCE | 2020年 / 35卷 / 25期
关键词：
Nasal Cannula; Oxygen; Mechanical Ventilation; Older Adults; NONINVASIVE VENTILATION; RESPIRATORY-FAILURE; EXTUBATION FAILURE;
D O I：
10.3346/jkms.2020.35.e194
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: Liberation and extubation are important for patients supported by mechanical ventilation. Extubation success is related to the duration of an intensive care unit (ICU) stay and mortality rate. High-flow nasal cannula (HFNC) oxygen therapy has physiological and clinical benefits in respiratory care. The present study compared clinical outcomes associated with HFNC and conventional oxygen therapy (COT) among patients at high risk for reintubation. Methods: A single-center randomized clinical trial was conducted between March 2018 and June 2019. Sixty adults admitted to the ICU and who were at high-risk of reintubation and met the inclusion criteria were enrolled in this study. "High risk" for reintubation was defined as having at least one of the following risk factors: age > 65 years, Acute Physiology and Chronic Health Evaluation II score > 12 points on extubation day, obesity, poor expectoration, airway patency problems, difficult or prolonged weaning, and more than one comorbidity. The primary outcome of interest was reintubation within 72 hours. Secondary outcomes included duration of ICU and hospital stay, mortality rate, and time to reintubation. Results: Of 60 patients, 31 received HFNC and 29 received COT (mean age, 78 +/- 7.8 vs. 76 +/- 6.5 years, respectively). Reintubation rate within 72 hours did not differ between the groups (3 patients [9.7%] vs. 1 patient [3.4%], respectively). Reintubation time was shorter among patients who received COT than among patients who received HFNC (0.5 hour vs. 25 hours), but this difference was not statistically significant. Duration of ICU did not differ between the groups (14.7 +/- 9.6 days vs. 13.8 +/- 15.7 days, for HFNC and COT, respectively). Conclusion: Among patients at high risk for reintubation, compared with COT, HFNC did not reduce the risk of reintubation within 72 hours.
引用
收藏
页数：10
相关论文
共 23 条
[1]  
Brotfain E, 2014, ISR MED ASSOC J, V16, P718
[2]   Heated and Humidified High-Flow Oxygen Therapy Reduces Discomfort During Hypoxemic Respiratory Failure [J].
Cuquemelle, Elise ;
Tai Pham ;
Papon, Jean-Francois ;
Louis, Bruno ;
Danin, Pierre-Eric ;
Brochard, Laurent .
RESPIRATORY CARE, 2012, 57 (10) :1571-1577
[3]   Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients [J].
El Solh, A. A. ;
Aquilina, A. ;
Pineda, L. ;
Dhanvantri, V. ;
Grant, B. ;
Bouquin, P. .
EUROPEAN RESPIRATORY JOURNAL, 2006, 28 (03) :588-595
[4]   Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation [J].
Epstein, SK ;
Ciubotaru, RL .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 158 (02) :489-493
[5]   High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial [J].
Fernandez, Rafael ;
Subira, Carles ;
Frutos-Vivar, Fernando ;
Rialp, Gemma ;
Laborda, Cesar ;
Ramon Masclans, Joan ;
Lesmes, Amanda ;
Panadero, Luna ;
Hernandez, Gonzalo .
ANNALS OF INTENSIVE CARE, 2017, 7
[6]   Early noninvasive ventilation averts extubation failure in patients at risk - A randomized trial [J].
Ferrer, M ;
Valencia, M ;
Nicolas, JM ;
Bernadich, O ;
Badia, JR ;
Torres, A .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 173 (02) :164-170
[7]   Sequential Application of Oxygen Therapy Via High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: An Observational Pilot Study [J].
Frat, Jean-Pierre ;
Brugiere, Benjamin ;
Ragot, Stephanie ;
Chatellier, Delphine ;
Veinstein, Anne ;
Goudet, Veronique ;
Coudroy, Remi ;
Petitpas, Franck ;
Robert, Rene ;
Thille, Arnaud W. ;
Girault, Christophe .
RESPIRATORY CARE, 2015, 60 (02) :170-178
[8]   Outcome of reintubated patients after scheduled extubation [J].
Frutos-Vivar, Fernando ;
Esteban, Andres ;
Apezteguia, Carlos ;
Gonzalez, Marco ;
Arabi, Yaseen ;
Restrepo, Marcos I. ;
Gordo, Federico ;
Santos, Cristina ;
Alhashemi, Jamal A. ;
Perez, Fernando ;
Penuelas, Oscar ;
Anzueto, Antonio .
JOURNAL OF CRITICAL CARE, 2011, 26 (05) :502-509
[9]   Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients A Randomized Clinical Trial [J].
Hernandez, Gonzalo ;
Vaquero, Concepcion ;
Colinas, Laura ;
Cuena, Rafael ;
Gonzalez, Paloma ;
Canabal, Alfonso ;
Sanchez, Susana ;
Luisa Rodriguez, Maria ;
Villasclaras, Ana ;
Fernandez, Rafael .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 316 (15) :1565-1574
[10]   Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients A Randomized Clinical Trial [J].
Hernandez, Gonzalo ;
Vaquero, Concepcion ;
Gonzalez, Paloma ;
Subira, Carles ;
Frutos-Vivar, Fernando ;
Rialp, Gemma ;
Laborda, Cesar ;
Colinas, Laura ;
Cuena, Rafael ;
Fernandez, Rafael .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (13) :1354-1361
123