No Impact of HFNC Flow Rate on Reintubation or NIV Use in Post-Extubation Patients, shows research

For this purpose, the researchers conducted a randomized controlled trial in which intubated patients were assigned to receive HFNC at either a 60 L/min or 40 L/min flow rate following extubation. The assigned flow rate was maintained for 24 hours. The primary outcome was a composite of reintubation or the need for non-invasive ventilation within 48 hours after extubation. Key secondary outcomes included any early adjustments to HFNC settings and mortality rates.

The study revealed the following findings:

• One hundred eighty patients were randomized, with 169 included in the analysis (86 in the 40 L/min group and 83 in the 60 L/min group).
• Primary outcome events occurred in 22.1% of patients in the 40 L/min group and 16.9% in the 60 L/min group (risk difference 5.2%).
• The 40 L/min group showed a higher risk of escalation in respiratory support, defined as using NIV or up-titration of HFNC settings, with 27.9% of patients requiring escalation compared to 9.6% in the 60 L/min group.

"In patients who were extubated, using a 60 L/min HFNC flow rate did not lower the risk of reintubation or needing NIV compared to a 40 L/min flow rate. Adjusting the 40 L/min flow rate as needed may be a good alternative to using the higher 60 L/min flow rate for post-extubation care. However, this study may not have had enough participants to detect small differences between the two groups," the researchers concluded.

Reference:

Ruan, S., Kuo, Y., Huang, C., Chien, Y., Huang, C., Kuo, L., Kuo, J. S. H., Chung, K., Ku, S., & Chien, J. (2024). Effect of Flow Rates of High-flow Nasal Cannula on Extubation Outcomes: A Randomized Controlled Trial. CHEST. https://doi.org/10.1016/j.chest.2024.12.021