Extubation success without using high-flow nasal cannula and non-invasive ventilation for patients with coronavirus disease 2019 (COVID-19): A retrospective observational study

Abstract

Background In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) to be a global pandemic. It was also reported that approximately 20%-23% of patients with COVID-19 admitted to the hospital required mechanical ventilation (MV). Reintubation rates ranged from 13–19%, leading to increased mortality. Moreover, exposure of health care workers is a serious problem and intubation is a high-risk procedure because of aerosol generation. To reduce reintubation, preventive high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) after extubation are recommended. However, using HFNC and NIV in patients with COVID-19 may lead to the spread of infection. Without using HFNC and NIV, conventional spontaneous breathing trial (SBT) may overestimate a patient’s respiratory status. A highly demanding SBT accurately assesses a patient’s reserve capacity and may reduce reintubation. We did not use preventive HFNC or NPPV and extubated with a highly demanding SBT protocol. This study aimed to evaluate whether our protocol can be performed safely.Methods This single-centre study was conducted at the Kawasaki Municipal Hospital from February 2020 to June 2020. Patients with COVID-19 requiring MV were screened for their eligibility for the weaning procedure every day. Patients were extubated after administering methylprednisolone if SBT was well tolerated. SBT was performed with 3 cmH2O pressure support, 3 cmH2O positive end-expiratory pressure, and ≤ 0.30 fraction of inspired oxygen. In extubated patients, the reintubation rate, duration of MV, length of intensive care unit (ICU) and hospital stay, and rate of ventilator-associated pneumonia (VAP) were analyzed.Results Ten patients received MV. Two of 10 patients had no improvement in their respiratory status and did not qualify for the extubation criteria and died. Eight patients were extubated. No reintubations were performed (0%). The median durations of MV, ICU stay, and hospital stay were 13 (interquartile range [IQR], 10–16) days, 17 (IQR, 13–27) days, and 22 (IQR, 16–26), and 3 patients (37.5%) was diagnosed VAP.Conclusions Extubation was performed with a highly demanding SBT protocol, and no patients were reintubated. All patients did not require HFNC and NIV. Further research is required in critically ill patients.