High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial

Abstract

Background: High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent postextubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. Methods: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). Results: Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group-risk difference of − 5.8% (95% CI, − 23.8-12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of − 50.0% (95% CI, − 74.6 to − 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p < 0.050). Twenty-four hours after extubation, the respiratory rate of the HFNC group had returned to baseline, but the NIV group was still

An Integrated Model including the ROX Index to Predict the Success of High-Flow Nasal Cannula Use after Planned Extubation: A Retrospective Observational Cohort Study

“…In clinical practice, HFNCs are used to manage acute respiratory failure (ARF), prevent hypoxemia during procedures, and prevent postextubation hypoxemia [1][2][3][4][5][6][7]. As almost 20% of patients who undergo planned extubation require reintubation because of hypoxemia, and the HFNC is a useful oxygen delivery modality in this setting, HFNCs are commonly used to prevent reintubation after planned extubation [4,5,[8][9][10][11][12]. As the HFNC can maintain the oxygen concentration despite a patient's declining status, clinicians may be hesitant to reintubate even if the patient's condition deteriorates.…”

The Comparison of Noninvasive Ventilation, High-Flow Oxygen Therapy and Conventional Oxygen Therapy for Weaning Failure in High-Risk Patients

“…Theoretically HFO had advantages over NIV as decreased risk of adverse effects like mouth dryness, leaks and pressure sores, easier clearance of secretions, and enhanced patient comfort [19] . Tan et al [23] emphasized this advantage with better tolerance and higher comfort than NIV besides similar WF among COPD patients after extubation. We did not investigate this aspect while the need for NIV or HFO more than 48 hours later was higher in the NIV group (72% vs 9.1%).…”

Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia

“…Previous physiological studies have illustrated that high-flow airflow can wash the nasopharyngeal dead space and produce a low level of 3-6 cmH 2 O positive endexpiratory pressure [14][15][16], which is the theoretical basis for HFNC in the treatment of mild hypercapnia. A few studies have suggested that HFNC can replace NIV for patients with hypercapnia [17,18], while it is generally not applicable to severe type 2 respiratory failure. However, the small sample sizes in these studies have left the specific indications for HFNC in the treatment of hypercapnia unclear.…”