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High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial

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dc.contributor.author Fernández, Rafael
dc.contributor.author Subira, Carles
dc.contributor.author Frutos Vivar, Fernando
dc.contributor.author Rialp, Gemma
dc.contributor.author Laborda, Cesar
dc.contributor.author Masclans Enviz, Joan Ramon
dc.contributor.author Lesmes, Amanda
dc.contributor.author Panadero, Luna
dc.contributor.author Hernández, Gonzalo
dc.date.accessioned 2018-03-22T08:39:59Z
dc.date.available 2018-03-22T08:39:59Z
dc.date.issued 2017
dc.identifier.citation Fernandez R, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Masclans JR 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 Dec;7(1):47. DOI: 10.1186/s13613-017-0270-9
dc.identifier.issn 2110-5820
dc.identifier.uri http://hdl.handle.net/10230/34234
dc.description.abstract 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. Postextubation 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.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher SpringerOpen
dc.relation.ispartof Annals of Intensive Care. 2017 Dec;7(1):47
dc.rights Copyright © The Author(s) 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
dc.rights.uri https://creativecommons.org/licenses/by/4.0/
dc.subject.other Respiració artificial
dc.subject.other Insuficiència respiratòria
dc.title High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1186/s13613-017-0270-9
dc.subject.keyword High-flow oxygen
dc.subject.keyword Mechanical ventilation
dc.subject.keyword Reintubation
dc.subject.keyword Weaning
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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