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Background <p>Re-intubation after planned extubation from invasive ventilation is frequently encountered in ICU practice and carries a higher incidence of morbidities and mortalities. We aim to compare high-flow nasal cannula (HFNC) to non-invasive ventilation (NIV) and conventional oxygen therapy (COT) immediately post-extubation from MV and to follow the incidence of reintubation and ICU outcomes.</p> Methods <p>This randomized clinical trial was conducted on 60 patients who were divided equally into 3 different groups according to oxygenation strategy after extubation from invasive MV (HFNC, COT, and NIV groups). The primary outcome was the re-intubation rate, while the secondary outcomes were ICU stay and 28-day mortality.</p> Results <p>The mean age of all patients was 62 ± 20&#xa0;years, 32 were male, and 21 were smokers. Clinical scores (SOFA and APACHE II), and co-morbidities were matched among the three groups. Both HFNC and NIV (4 patients, 20% in each group) were associated with a significantly lower rate of re-intubation than the COT group (10 patients, 50%) with a <i>p</i>-value &lt; 0.05. The COT group (12.2 ± 6&#xa0;days) is associated with prolonged ICU stay relative to either HFNC or NIV (8.1 ± 3 or 7.5 ± 3.2) with a <i>p</i>-value of 0.04 for both. ICU and 28-day mortalities were not significantly different among the three groups.</p> Conclusion <p>High-flow nasal cannula and non-invasive mechanical ventilation decreased the rate of re-intubation after successful extubation with better oxygenation and lower ICU stay than conventional oxygen therapy.</p> Trial registration <p>Clinicaltrials.gov [NCT04441736].</p>

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Different oxygenation modalities for early post-extubation: a single center randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月10日

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  • Walid Omar Ahmed,
  • Farouk Mohamed,
  • Yasser Sadek Nassar,
  • Farouk Mostafa Faris

摘要

Background

Re-intubation after planned extubation from invasive ventilation is frequently encountered in ICU practice and carries a higher incidence of morbidities and mortalities. We aim to compare high-flow nasal cannula (HFNC) to non-invasive ventilation (NIV) and conventional oxygen therapy (COT) immediately post-extubation from MV and to follow the incidence of reintubation and ICU outcomes.

Methods

This randomized clinical trial was conducted on 60 patients who were divided equally into 3 different groups according to oxygenation strategy after extubation from invasive MV (HFNC, COT, and NIV groups). The primary outcome was the re-intubation rate, while the secondary outcomes were ICU stay and 28-day mortality.

Results

The mean age of all patients was 62 ± 20 years, 32 were male, and 21 were smokers. Clinical scores (SOFA and APACHE II), and co-morbidities were matched among the three groups. Both HFNC and NIV (4 patients, 20% in each group) were associated with a significantly lower rate of re-intubation than the COT group (10 patients, 50%) with a p-value < 0.05. The COT group (12.2 ± 6 days) is associated with prolonged ICU stay relative to either HFNC or NIV (8.1 ± 3 or 7.5 ± 3.2) with a p-value of 0.04 for both. ICU and 28-day mortalities were not significantly different among the three groups.

Conclusion

High-flow nasal cannula and non-invasive mechanical ventilation decreased the rate of re-intubation after successful extubation with better oxygenation and lower ICU stay than conventional oxygen therapy.

Trial registration

Clinicaltrials.gov [NCT04441736].