2026-06-14T03:30:38Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/204282024-11-29T03:33:04Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967col_20.500.12105_16983

00925njm 22002777a 4500 dc Fernandez, Rafael author Subira, Carles author Frutos-Vivar, Fernando author Rialp, Gemma author Laborda, Cesar author Ramon Masclans, Joan author Lesmes, Amanda author Panadero, Luna author Hernandez, Gonzalo author 2017-05-02 Background: Extubation failure is associated with increased morbidity and mortality, but cannot be safely predicted or avoided. High-flow nasal cannula (HFNC) prevents postextubation respiratory failure in low-risk patients. Objective: To demonstrate that HFNC reduces postextubation respiratory failure in high-risk non-hypercapnic patients compared with conventional oxygen. Methods: Randomized, controlled multicenter trial in patients who passed a spontaneous breathing trial. We enrolled patients meeting criteria for high-risk of failure to randomly receive HFNC or conventional oxygen for 24 h after extubation. Primary outcome was respiratory failure within 72-h postextubation. Secondary outcomes were reintubation, intensive care unit (ICU) and hospital lengths of stay, and mortality. Statistical analysis included multiple logistic regression models. Results: The study was stopped due to low recruitment after 155 patients were enrolled (78 received high-flow and 77 received conventional oxygen). Groups were similar at enrollment, and all patients tolerated 24-h HFNC. Post-extubation respiratory failure developed in 16 (20%) HFNC patients and in 21 (27%) conventional patients [OR 0.69 (0.31-1.54), p = 0.2]. Reintubation was needed in 9 (11%) HFNC patients and in 12 (16%) conventional patients [OR 0.71 (0.25-1.95), p = 0.5]. No difference was found in ICU or hospital length of stay, or mortality. Logistic regression models suggested HFNC [OR 0.43 (0.18-0.99), p = 0.04] and cancer [OR 2.87 (1.04-7.91), p = 0.04] may be independently associated with postextubation respiratory failure. Conclusion: Our study is inconclusive as to a potential benefit of HFNC over conventional oxygen to prevent occurrence of respiratory failure in non-hypercapnic patients at high risk for extubation failure. Fernandez R, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Ramon Masclans J, et al. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Ann Intensive Care. 2017 May 02;7:47. Epub 2017 May 2. 10.1186/s13613-017-0270-9 2110-5820 Annals of Intensive Care http://hdl.handle.net/20.500.13003/9834 28466461 L615855054 2-s2.0-85018978960 http://hdl.handle.net/20.500.12105/20428 404770600002 Mechanical ventilation Weaning Reintubation High-flow oxygen High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial