Rationale: When compared to VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. Objective: To establish whether high-flow oxygen prevents endotracheal re-intubation in hypoxemic patients after extubation, as compared to VenturiMask. Methods: In this multicentre randomized trial, 494 patients exhibiting PaO2:FiO2 ratio≤300 mmHg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before re-intubation. High-flow use in VenturiMask group was not permitted. Measurements and main results: The primary outcome was the rate of re-intubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included re-intubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n=492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required re-intubation at 72 hours (unadjusted odds ratio 1.26 [95%CI 0.70-2.26], p=0.49). At 28 days, the rate of re-intubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio 0.89 [95%CI 0.60-1.31], p=0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% vs. 17%, adjusted hazard ratio 0.39 [95%CI 0.22- 0.71], p=0.002; at 28 days, 12% vs. 21%, adjusted hazard ratio 0.52 [95%CI 0.32-0.83], p=0.007. Conclusions: Re-intubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded to less frequent use of rescue noninvasive ventilation.

High-Flow Versus VenturiMask Oxygen Therapy to Prevent Re-Intubation in Hypoxemic Patients After Extubation: A Multicenter, Randomized Clinical Trial

Maggiore, Salvatore Maurizio
;
2022-01-01

Abstract

Rationale: When compared to VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. Objective: To establish whether high-flow oxygen prevents endotracheal re-intubation in hypoxemic patients after extubation, as compared to VenturiMask. Methods: In this multicentre randomized trial, 494 patients exhibiting PaO2:FiO2 ratio≤300 mmHg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before re-intubation. High-flow use in VenturiMask group was not permitted. Measurements and main results: The primary outcome was the rate of re-intubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included re-intubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n=492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required re-intubation at 72 hours (unadjusted odds ratio 1.26 [95%CI 0.70-2.26], p=0.49). At 28 days, the rate of re-intubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio 0.89 [95%CI 0.60-1.31], p=0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% vs. 17%, adjusted hazard ratio 0.39 [95%CI 0.22- 0.71], p=0.002; at 28 days, 12% vs. 21%, adjusted hazard ratio 0.52 [95%CI 0.32-0.83], p=0.007. Conclusions: Re-intubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded to less frequent use of rescue noninvasive ventilation.
File in questo prodotto:
File Dimensione Formato  
FINAL Blue-202201-0065OC.R2_Proof_hi.pdf

Open Access dal 16/12/2023

Descrizione: Articolo principale
Tipologia: Documento in Post-print
Dimensione 576.99 kB
Formato Adobe PDF
576.99 kB Adobe PDF Visualizza/Apri
rccm.202201-0065oc.pdf

Solo gestori archivio

Tipologia: PDF editoriale
Dimensione 698.95 kB
Formato Adobe PDF
698.95 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11564/786671
Citazioni
  • ???jsp.display-item.citation.pmc??? 14
  • Scopus 17
  • ???jsp.display-item.citation.isi??? 19
social impact