November 04, 2016
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High-flow oxygen therapy noninferior to noninvasive ventilation

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High-flow conditioned oxygen therapy was not inferior to noninvasive ventilation for reducing reintubation and postextubation respiratory failure in patients at high-risk for reintubation, according to clinical trial data published in JAMA.

“High-flow conditioned oxygen therapy delivered through nasal cannula and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation,” Gonzalo Hernández, MD, PhD, of Hospital Virgen de la Salud in Toledo, Spain, and colleagues wrote.

“Compared with noninvasive mechanical ventilation (NIV), high-flow conditioned oxygen therapy has some advantages, such as greater patient comfort, lower costs, greater availability, and some additional pathophysiological mechanisms not offered with NIV (eg, conditioning the air),” they added.

“However, the evidence supporting [high-flow conditioned oxygen therapy] in patients at high risk of reintubation is inconclusive.”

Hernández and colleagues performed a noninferiority trial between September 2012 and October 2014 to assess the ability of high-flow conditioned oxygen therapy through nasal prongs to prevent postextubation respiratory failure and reintubation in high-risk patients in relation to NIV.

They enrolled 604 critically ill patients (mean age, 65 years; 64% men) from 3 intensive care units in Spain who received mechanical ventilation (MV) for over more than 12 hours and were ready for planned extubation. All subjects had at least one high-risk factor for reintubation, such as age over 65 years, body mass index >greater than 30, moderate to severe chronic obstructive pulmonary disease or prolonged mechanical ventilation MV. Participants were randomly selected to receive either noninvasive mechanical ventilation NIV (n = 314) or high-flow conditioned oxygen therapy (n = 290) for 24 hours following extubation.

Data showed that reintubation was not required for 22.8% (n = 66) of the high-flow group or 19.1% (n = 60) of the noninvasive mechanical ventilation NIV group (absolute difference, −3.7%; 95% CI, −9.1% to ∞). A greater proportion of patients in the noninvasive mechanical ventilation NIV group (39.8%; n = 125) experienced postextubation respiratory failure than the high-flow group (26.9%; n = 78) within 72 hours (risk difference, 12.9%; 95% CI, 6.6% to ∞).

The researchers did not observe a significant difference in median time to reintubation between the groups (high-flow group, 26.5 hours [IQR, 14-39 hours] vs. noninvasive mechanical ventilation NIV group, 21.5 hours [IQR, 10-47 hours]). The absolute difference of median time to reintubation among the two groups was −5 hours (95% CI, −34 to 24 hours). The high-flow group had a lower median postrandomization ICU length of stay (3 days; IQR, 2-7) than the NIV group ( vs. 4 days; IQR, 2-9; P = .048). Other secondary outcomes — such as respiratory infection, sepsis and multiple organ failure — were similar among both groups. No patients in the high-flow group compared with 42.9% of patients in the noninvasive mechanical ventilation NIV group experienced adverse effects requiring resignation of treatment.

“Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to noninvasive mechanical ventilation NIV for preventing reintubation and postextubation respiratory failure,” Hernández and colleagues concluded. “High-flow conditioned oxygen therapy may offer advantages for these patients.” – by Alaina Tedesco

Disclosure: The researchers report not relevant financial disclosures.