High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial
Abstract Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. N...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-09-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-021-00922-5 |
| _version_ | 1818589131803983872 |
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| author | Surat Tongyoo Porntipa Tantibundit Kiattichai Daorattanachai Tanuwong Viarasilpa Chairat Permpikul Suthipol Udompanturak |
| author_facet | Surat Tongyoo Porntipa Tantibundit Kiattichai Daorattanachai Tanuwong Viarasilpa Chairat Permpikul Suthipol Udompanturak |
| author_sort | Surat Tongyoo |
| collection | DOAJ |
| description | Abstract Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. Methods We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Results Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50–77] vs. 65.5 [54–77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3–8] days in the HFNC group vs. 5 [3–9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70–1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57–1.37); P = 0.59). Conclusions Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3 |
| first_indexed | 2024-12-16T09:35:47Z |
| format | Article |
| id | doaj.art-6d7572288b624d4ea9e8f40f493bcc75 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-16T09:35:47Z |
| publishDate | 2021-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6d7572288b624d4ea9e8f40f493bcc752022-12-21T22:36:25ZengSpringerOpenAnnals of Intensive Care2110-58202021-09-0111111010.1186/s13613-021-00922-5High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trialSurat Tongyoo0Porntipa Tantibundit1Kiattichai Daorattanachai2Tanuwong Viarasilpa3Chairat Permpikul4Suthipol Udompanturak5Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDivision of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDivision of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDivision of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDivision of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityOffice of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityAbstract Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. Methods We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Results Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50–77] vs. 65.5 [54–77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3–8] days in the HFNC group vs. 5 [3–9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70–1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57–1.37); P = 0.59). Conclusions Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3https://doi.org/10.1186/s13613-021-00922-5High flow nasal cannulaNon-invasive mechanical ventilationSepsisExtubationExtubation failureReintubation |
| spellingShingle | Surat Tongyoo Porntipa Tantibundit Kiattichai Daorattanachai Tanuwong Viarasilpa Chairat Permpikul Suthipol Udompanturak High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial Annals of Intensive Care High flow nasal cannula Non-invasive mechanical ventilation Sepsis Extubation Extubation failure Reintubation |
| title | High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial |
| title_full | High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial |
| title_fullStr | High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial |
| title_full_unstemmed | High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial |
| title_short | High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial |
| title_sort | high flow nasal oxygen cannula vs noninvasive mechanical ventilation to prevent reintubation in sepsis a randomized controlled trial |
| topic | High flow nasal cannula Non-invasive mechanical ventilation Sepsis Extubation Extubation failure Reintubation |
| url | https://doi.org/10.1186/s13613-021-00922-5 |
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