High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery

2021

BMC Pulm Med

Background To investigate the indications for high-flow nasal cannula oxygen (HFNC) therapy in patients with hypoxemia during ventilator weaning and to explore the predictors of reintubation when treatment fails. Methods Adult patients with hypoxemia weaning from mechanical ventilation were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were assigned to the treatment group or control group according to whether they were receiving HFNC or non-invasive ventilation (NIV) after extubation. The 28-day mortality and 28-day reintubation rates were compared between the two groups after Propensity score matching (PSM). The predictor for reintubation was formulated according to the risk factors with the XGBoost algorithm. The areas under the receiver operating characteristic curve (AUC) was calculated for reintubation prediction according to values at 4 h after extubation, which was compared with the ratio of SpO2/FiO2 to respiratory rate (ROX index). Results A total of 524,520 medical records were screened, and 801 patients with moderate or severe hypoxemia when undergoing mechanical ventilation weaning were included (100 < PaO2/FiO2 ≤ 300 mmHg), including 358 patients who received HFNC therapy after extubation in the treatment group. There were 315 patients with severe hypoxemia (100 < PaO2/FiO2 ≤ 200 mmHg) before extubation, and 190 patients remained in the treatment group with median oxygenation index 166[157,180] mmHg after PSM. There were no significant differences in the 28-day reintubation rate or 28-day mortality between the two groups with moderate or severe hypoxemia (all P > 0.05). Then HR/SpO2 was formulated as a predictor for 48-h reintubation according to the important features predicting weaning failure. According to values at 4 h after extubation, the AUC of HR/SpO2 was 0.657, which was larger than that of ROX index (0.583). When the HR/SpO2 reached 1.2 at 4 h after extubation, the specificity for 48-h reintubation prediction was 93%. Conclusions The treatment effect of HFNC therapy is not inferior to that of NIV, even on patients with oxygenation index from 160 to 180 mmHg when weaning from ventilator. HR/SpO2 is more early and accurate in predicting HFNC failure than ROX index.

Section: Discussionmentioning

confidence: 99%

Effects of high-flow oxygen therapy on patients with hypoxemia after extubation and predictors of reintubation: a retrospective study based on the MIMIC-IV database

2021

BMC Pulm Med

“…HFNCs can provide constant air ow and oxygen concentration with a small amount of positive end-expiratory pressure [11][12][13]. Therefore, the therapeutic effect of HFNC is better than that of conventional oxygen, including nasal catheters and facemasks [6,14,15]. Most research designs in recent years have been noninferior studies of HFNC and NIV, but the speci c indication of hypoxemia is not clear.…”

Section: Discussionmentioning

confidence: 99%

Effects of high-flow oxygen therapy on patients with hypoxemia after extubation and predictors of reintubation: a retrospective study based on the MIMIC-IV database

2021

Preprint

Purpose: To investigate the indications for high-flow nasal cannula oxygen (HFNC) therapy in patients with hypoxemia during ventilator weaning and to explore the predictors of reintubation when treatment fails.Methods: Adult patients with hypoxemia weaning from mechanical ventilation were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were assigned to the treatment group or control group according to whether they were receiving HFNC or non-invasive ventilation (NIV) after extubation. The 28-day mortality and 28-day reintubation rates were compared between the two groups after Propensity score matching (PSM). The predictor for reintubation was formulated according to the risk factors with the XGBoost algorithm. The areas under the receiver operating characteristic curve (AUC) was calculated for reintubation prediction according to values at 4 hours after extubation, which was compared with the ratio of SpO2/FiO2 to respiratory rate (ROX index).Results: A total of 524520 medical records were screened, and 801 patients with moderate or severe hypoxemia when undergoing mechanical ventilation weaning were included (100<PaO2/FiO2≤300 mmHg), including 358 patients who received HFNC therapy after extubation in the treatment group. There were 315 patients with severe hypoxemia (100<PaO2/FiO2≤200 mmHg) before extubation, and 190 patients remained in the treatment group with median oxygenation index 166[157,180] mmHg after PSM. There were no significant differences in the 28-day reintubation rate or 28-day mortality between the two groups with moderate or severe hypoxemia (all P>0.05). Then HR/SpO2 was formulated as a predictor for 48-hour reintubation according to the important features predicting weaning failure. According to values at 4 hours after extubation, the AUC of HR/SpO2 was 0.657, which was larger than that of ROX index (0.583). When the HR/SpO2 reached 1.2 at 4 hours after extubation, the specificity for 48-hour reintubation prediction was 93%. Conclusions: The treatment effect of HFNC therapy is not inferior to that of NIV, even on patients with oxygenation index from 160 to 180 mmHg when weaning from ventilator. HR/SpO2 is more early and accurate in predicting HFNC failure than ROX index.

“…High-flow oxygen therapy provides constant airflow and oxygen concentration, which has been found more effective than conventional oxygen therapies such as nasal catheter and mask oxygen [11][12][13]. For patients with mild to moderate hypoxemia, the effect of HFNC is not inferior to that of NIV [5,6].…”

Section: Discussionmentioning

confidence: 99%

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

Su¹,

et al. 2021

Lung

Objectives To investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails. Methods This retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45 < PaCO 2 ≤ 60 mmHg) received either HFNC or non-invasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan-Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality and 48-h and 28-day intubation rates were compared using the Chi-squared test. The predictive performances of HR/SpO 2 and the ROX index (the ratio of SpO 2 /FiO 2 to respiratory rate) at 4 h were assessed regarding HFNC failure, which was determined if intubation was given within 48 h after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO 2 and the ROX index were calculated and compared. Results A total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-h intubation rate between the HFNC group (the treatment group) and the NIV group (the control group) (14.2% vs. 8.5%, p = 0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, p = 0.029), higher 28-day mortality (17.9% vs. 8.5%, p = 0.043), and longer ICU length of stay (4.4 vs. 3.3 days, p = 0.019), compared to those of NIV group. The AUC of HR/SpO 2 at 4 h after the initiation of HFNC yielded around 0.660 for predicting 48-h intubation, greater than that of the ROX index with an AUC of 0.589 (p < 0.01). Conclusion Patients with impending respiratory failure had lower intubation rate, shorter ICU length of stay, and lower mortality when treated mild hypercapnia with NIV over HFNC. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO 2 in predicting the failure of HFNC among these patients. Keywords High-flow nasal cannula • Hypercapnia • Non-invasive mechanical ventilation • MIMIC Abbreviations HFNC High-flow nasal cannula NIV Non-invasive ventilation MIMIC-