التفاصيل البيبلوغرافية
| العنوان: |
High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. |
| المؤلفون: |
Fernandez, Rafael, Subira, Carles, Frutos-Vivar, Fernando, Rialp, Gemma, Laborda, Cesar, Masclans, Joan, Lesmes, Amanda, Panadero, Luna, Hernandez, Gonzalo |
| المصدر: |
Annals of Intensive Care; 5/2/2017, Vol. 7 Issue 1, p1-7, 7p |
| مصطلحات موضوعية: |
RESPIRATORY insufficiency, HYPERCAPNIA, EXTUBATION, MULTIPLE regression analysis, PATIENTS, THERAPEUTICS |
| مستخلص: |
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. Registered at Clinicaltrials.gov NCT01820507. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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