Failure of high-flow nasal cannula therapy may delay intubation and increase mortality

Kang, Byung Ju; Koh, Younsuck; Lim, Chae‐Man; Huh, Jin Won; Baek, Seunghee; Han, Myung Woul; Seo, H; Suh, Hee Jung; Seo, Ga Jin; Kim, Eun Young; Hong, Sang-Bum

doi:10.1007/s00134-015-3693-5

Cited by 521 publications

(467 citation statements)

References 36 publications

Supporting

Mentioning

419

Contrasting

Unclassified

Order By: Relevance

“…These results also remind us of the reports on non-invasive mechanical ventilation (NIV) that showed many years ago that NIV failure could be strongly associated with higher mortality in such patients [10], inasmuch as NIV failure occurred late [11]. However, the study by Kang et al [8] does not tell us that HFNC should not be used in acute hypoxemic acute respiratory failure. Nevertheless, it suggests that HFNC should be stopped early in patients who are at high risk of intubation.…”

mentioning

confidence: 70%

“…The retrospective study by Kang et al [8] enrolled all patients who received HFNC therapy that eventually failed and who were subsequently intubated. Patients were Intensive Care Med (2015) 41:1673-1675 DOI 10.1007/s00134-015-3855-5 EDITORIAL classified according to whether failure occurred early (within 48 h) or late (at least 48 h) after the initiation of HFNC.…”

mentioning

confidence: 99%

See 1 more Smart Citation

High flow oxygen cannula: the other side of the moon

Demoule

Rello

2015

Intensive Care Med

View full text Add to dashboard Cite

mentioning

confidence: 70%

mentioning

confidence: 99%

High flow oxygen cannula: the other side of the moon

Demoule

Rello

2015

Intensive Care Med

View full text Add to dashboard Cite

“…Kang et al [3] analysed the impact of the timing of ETI relative to the determination of HFNC failure. We feel that this estimation warrants consideration.…”

mentioning

confidence: 99%

“…First, from a methodological standpoint, Kang et al [3] enrolled patients with multiple reasons for AHRF. Defining two cohorts on the basis of early or late ETI but having those cohorts contain different numbers of patients with each etiologic category of AHRF makes it difficult to determine the independent contribution of timing of ETI to the outcomes of interest.…”

mentioning

confidence: 99%

“…To adjust for confounding factors and heterogeneity in baseline attributes of patients in their study, Kang et al [3] use propensity score analyses to compare early and late ETI groups. This strategy is essentially a form of multivariate adjustment for covariates and has the advantage of identifying two groups with similar baseline characteristics, which facilitates their comparison on the basis of an endpoint, like timing of ETI.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Failure of high-flow nasal cannula and delayed intubation: a new harmful sequence?

2015

View full text Add to dashboard Cite

Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients

Hernández

Vaquero

Colinas

et al. 2016

JAMA

491

435

View full text Add to dashboard Cite

IMPORTANCE High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms.OBJECTIVE To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. DESIGN, SETTING, AND PARTICIPANTSMulticenter randomized clinical trial in 3 intensive care units in Spain (September 2012-October 2014) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation: older than 65 years; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day; body mass index higher than 30; inadequate secretions management; difficult or prolonged weaning; more than 1 comorbidity; heart failure as primary indication for mechanical ventilation; moderate to severe chronic obstructive pulmonary disease; airway patency problems; or prolonged mechanical ventilation. INTERVENTIONSPatients were randomized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation. MAIN OUTCOMES AND MEASURES Primary outcomes were reintubation and postextubation respiratory failure within 72 hours. Noninferiority margin was 10 percentage points. Secondary outcomes included respiratory infection, sepsis, and multiple organ failure, length of stay and mortality; adverse events; and time to reintubation. RESULTS Of 604 patients (mean age, 65 [SD, 16] years; 388 [64%] men), 314 received NIV and 290 high-flow oxygen. Sixty-six patients (22.8%) in the high-flow group vs 60 (19.1%) in the NIV group were reintubated (absolute difference, −3.7%; 95% CI, −9.1% to ϱ); 78 patients (26.9%) in the high-flow group vs 125 (39.8%) in the NIV group experienced postextubation respiratory failure (risk difference, 12.9%; 95% CI, 6.6% to ϱ). Median time to reintubation did not significantly differ: 26.5 hours (IQR, 14-39 hours) in the high-flow group vs 21.5 hours (IQR, 10-47 hours) in the NIV group (absolute difference, −5 hours; 95% CI, −34 to 24 hours). Median postrandomization ICU length of stay was lower in the high-flow group, 3 days (IQR, 2-7) vs 4 days (IQR, 2-9; P=.048). Other secondary outcomes were similar in the 2 groups. Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9% patients in the NIV group (P < .001).CONCLUSIONS AND RELEVANCE Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients.

show abstract

Failure of high-flow nasal cannula therapy may delay intubation and increase mortality

Abstract: Failure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.

Cited by 521 publications

References 36 publications

High flow oxygen cannula: the other side of the moon

High flow oxygen cannula: the other side of the moon

Failure of high-flow nasal cannula and delayed intubation: a new harmful sequence?

Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients

Contact Info

Product

Resources

About