High-Flow Nasal Cannula Versus Standard Oxygen Therapy After Extubation in Liver Transplantation: A Matched Controlled Study

Abstract

BACKGROUND: High-flow nasal cannula (HFNC) is a key component of oxygen therapy and has largely been used in patients with acute respiratory failure. We conducted a matched controlled study with the aim to compare the preventive use of oxygen therapy delivered by HFNC versus via air-entrainment mask (standard O 2) after extubation in adult subjects with liver transplantation for reducing postextubation hypoxemia. METHODS: Twenty-nine subjects with liver transplantation who received HFNC after extubation (HFNC group) were matched 1:1 with 29 controls (standard O 2 group) chosen from an historical group of 90 subjects admitted to the ICU during the previous 36 months. The primary outcome of the study was the incidence of hypoxemia at 1 h and 24 h after extubation. Secondary outcomes were the rate of weaning failure, ICU length of stay, and 28-d mortality. RESULTS: The incidence of hypoxemia was not significantly different between the HFNC and standard O 2 groups at 1 h and 24 h after extubation. In the HFNC group, there was a trend toward a lower rate of weaning failure compared with the standard O 2 group. ICU length of stay and 28-d mortality were similar in both groups. CONCLUSIONS: Early application of HFNC in the subjects with liver transplantation did not reduce the incidence of hypoxemia after extubation compared with standard O 2 and did not modify the incidence of weaning failure, ICU length of stay, and 28-d mortality in this high-risk population of subjects. (ClinicalTrials.gov registration NCT03441854.

High-Flow Nasal Cannula After Surgery–A Lateral Move From Conventional Oxygen Therapy?

“…The nonsuperiority of HFNC over standard oxygen therapy in postoperative subjects reported by Gaspari et al 1 is in agreement with the results of similar studies, which included subjects who had undergone major abdominal surgery, 2 lung resection, 3 or cardiac surgery (both obese 4 and normal weight) subjects. 5 Based on this and previous studies, can we state that HFNC should not be used in postoperative patients?…”

“…7 But these effects would not have much, if any, effect on the more common causes of postoperative hypoxemia, such as atelectasis, aspiration, or pneumonia. 8 The equivalence in hypoxemia seen in the study by Gaspari et al, 1 which was not expected, may not be surprising because of the protocols for oxygen delivery. The F IO 2 in both groups of subjects was titrated to maintain an S pO 2 of Ն93%.…”

“…In a study of subjects with liver transplantation published in the current issue of RESPIRATORY CARE, Gaspari et al 1 assessed whether preventive use of oxygen therapy delivered by high-flow nasal cannula (HFNC) reduced postextubation hypoxemia more effectively than did oxygen therapy delivered with an air-entrainment mask (standard O 2 ). Twenty-nine subjects were prospectively recruited into the HFNC group.…”

AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting

“…Assessment of the use of HFNC compared to conventional oxygen therapy immediately after extubation was the objective of several RCTs. [52][53][54][55][56][57][58][59] Hospital and ICU LOS were not different. Herna ´ndez et al 52 found lower re-intubation within 72 h of extubation using HFNC compared to conventional oxygen therapy in subjects at low risk of extubation failure (P ¼ .004).…”

Weaning von invasiver Beatmung

“…Nach mehreren Metaanalysen [ 19 , 20 , 21 , 22 ] kann High-flow-Sauerstoff

High-flow-Sauerstoff

beim primär hypoxämischem Versagen als Alternative zur NIV eingesetzt werden. Angesichts heterogener Patientengruppen mit unterschiedlichen Risiken für ein Postextubationsversagen zeigen Studiendaten sowie Metaanalysen keinen konsistenten Vorteil der High-flow-Therapie gegenüber der reinen Sauerstoff- oder NIV-Therapie zur Reintubationsvermeidung und insbesondere nicht bezüglich des Outcomes, einschließlich der Intensivmortalität [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Vielmehr zeigt eine aktuelle Arbeit von Thille et al.…”