No Impact of HFNC Flow Rate on Reintubation or NIV Use in Post-Extubation Patients, shows research
Taiwan: A study comparing high-flow nasal cannula (HFNC) flow rates of 60 L/min and 40 L/min in post-extubation patients found no significant differences in outcomes, including the need for reintubation or non-invasive ventilation (NIV) within 48 hours. However, the group using 40 L/min had a higher likelihood of requiring escalated respiratory support, such as NIV or HFNC up-titration. This suggests that using a 40 L/min flow rate with adjustments as needed could be a viable alternative for managing these patients.
The findings were published online in the CHEST Journal on December 30, 2024.
High-flow nasal cannula has become a promising intervention for post-extubation oxygen therapy, with the potential to reduce the need for reintubation. However, it remains uncertain whether higher flow rates offer better outcomes than the commonly used 30-50 L/min range. Sheng-Yuan Ruan, From the Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan, and colleagues aimed to compare the effects of HFNC flow rates set at 60 L/min versus 40 L/min on post-extubation outcomes, particularly in terms of reintubation rates and the need for additional respiratory support.
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
