Use of Non-invasive ventilation and high-flow nasal catheter prevents extubation failure, ICU mortality

China: A study published in the Frontiers in Medicine, in the section of Intensive Care Medicine and Anesthesiology, has concluded that the most effective method which prevents reintubation, respiratory failure, and ICU death in high-risk patients with evidence of extubation failure is use of Non-invasive ventilation (NIV) and high-flow nasal catheter (HFNC). The study also mentioned that HFNC alone is the most effective in shortening ICU stay and length of hospital stay (LOS).

In critically ill patients with high-risk factors, extubation failure is associated with poor prognosis. After extubation, prophylactic use of oxygen therapy has been introduced, but there is a non-clarity regarding the best respiratory support method.

Considering this critical factor and researching the best respiratory support method, Dr. Zheng led a team of researchers from the Department of Pulmonary and Critical Care Medicine and the Department of Thoracic Surgery at The First Affiliated Hospital from Chongqing Medical University to evaluate four post-extubation respiratory support for their effectiveness and their approach regarding reduced reintubation and respiratory failure in patients who are at high-risk of extubation failure.

The critical points of the study are:

o The database searched was Cochrane, PubMed, EMBASE, and Web of Science.

o RCTs were reviewed reviewing post-extubation preventive use of respiratory management strategies, including conventional oxygen therapy (COT), NIV, and HFNC.

o Reintubation rate and respiratory failure were the primary outcomes, while ICU mortality, ICU stay, and LOS were the secondary outcomes.

o The study included 17 RCTs, including 2813 participants enrolled in the study.

o NIV, HFNC, and NIV + HFNC effectively prevented reintubation and had an odds ratio (OR) of 0.46, 0.26, and OR, respectively.

o The respiratory failure had OR 0.23, 0.15, and 0.26 in NIV, HFNC, and NIV + HFNC, respectively.

o The ICU mortality was reduced in NIV and NIV + HFNC with OR 0.40 and 0.32, respectively.

o In terms of reintubation rate, respiratory failure, and ICU mortality based on SUCRA score, NIV + HFNC was ranked best with a recorded score of 99.3, 87.1, and 88.2, respectively.

o ICU stay and LOS had no significant difference in other methods.

o HFNC ranked first based on SUCRA in shortening ICU stay and LOS.

The researcher concluded a Combo of NIV and HFNC is probably the most effective respiratory support method in high-risk patients with extubation failure. At the same time, HFNC alone is the best method to shorten ICU stay and LOS.

The researchers wrote "Results of our study are informative in selecting appropriate non-invasive oxygen therapy for post-extubation patients. But the study has limitations for high-risk patients, lacks consistency, and lacks sensitivity analyses." They wrote, " we didn't consider the safety and economic benefits of the four methods as we had limited data."

Further reading:

Efficacy of preventive oxygen therapy after planned extubation in high-risk patients with extubation failure: A network meta-analysis of randomized controlled trials. SYSTEMATIC REVIEW article Front. Med., 13 October 2022 Sec. Intensive Care Medicine and Anesthesiology