Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study

Abstract

Introduction: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed postextubation HFNC. Methods: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. Results: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83–3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, P<0.001), ICU mortality (14.6% versus 2.0%, P<0.001) and hospital mortality (29.3% versus 12.3%, P=0.006). Conclusion: Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure. Keywords: Adult, airway extubation, high-flow nasal cannula, mechanical ventilation, respiratory failure

The Respiratory Rate-Oxygenation Index predicts failure of post-extubation high-flow nasal cannula therapy in intensive care unit patients: a retrospective cohort study

“…( 19 ) In the last year, Kansal et al reported in a multicenter observational study that 16.8% (41/244) of their extubated patients had HFNC failure ≤ 7 days. ( 20 ) However, detailing the baseline characteristics of the above patients, our patients had higher SOFA scores and more compromised ventilatory laboratories, which indicates that our cohort included patients with greater severity, which could be why our rate of HFNC failure was higher. These previous results support our findings and highlight the health burden of these complications and the importance of finding an early predictor of HFNC treatment failure in extubated patients.…”