Prognostic factors for extubation failure in high risk patients using high-flow nasal cannula

Ezcurra, Paulina; Venuti, María Sofia; Gogniat, Emiliano; Ducrey, Marcela; Dianti, José; Midley, Alejandro; Giannasi, Sergio; Román, Eduardo San; Roux, N.

doi:10.1183/13993003.congress-2019.pa4022

Cited by 1 publication

(3 citation statements)

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“…Our results differ from two recent smaller singlecentre retrospective studies of patients extubated to HFNC (84 and 165 patients, respectively). 24,25 These studies identified longer hospital LOS and duration of MV prior to extubation, respectively as variables associated with re-intubation. Different patient case-mix (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 Interestingly, post-extubation HFNC usage studies including our study have not demonstrated these risk factors to be predictive of failed HFNC. 10,24,25 On the other hand, post-extubation HFNC has neither been shown to reduce the risk of re-intubation consistently across various studies; despite decreasing the incidence of post-extubation respiratory failure. 29,31 This may highlight the need to further study the role of postextubation HFNC in larger studies to identify which patients are unlikely to benefit.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only a few observational studies have attempted to address this question, and report inconsistent results. 24,25 In addition, while re-intubation in the non-HFNC settings has been associated with poorer outcomes, [4][5][6] evidence suggestive of poorer outcomes is limited among patients with post-extubation HFNC failure. 26 We therefore aimed to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC.…”

Section: Introductionmentioning

confidence: 99%

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

Kansal

Dhanvijay

et al. 2021

Ann Acad Med Singap

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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

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Section: Discussionmentioning

confidence: 99%