High Flow Oxygen Reduces Reintubation Risk For Critically Ill

According to a new study published in JAMA, critically ill patients extubated from mechanical ventilation were less likely to be reintubated within 72 hours if  they received high-flow oxygen therapy via nasal cannula compared to conventional oxygen therapy. Gonzalo Hernandez, MD, PhD, of Hospital Virgen de la Salud, Madrid, Spain and colleagues randomly assigned 527 mechanically ventilated patients at low risk for reintubation to undergo either high-flow or conventional oxygen therapy for 24 hours after extubation. The study was presented at the International Symposium on Intensive Care and Emergency Medicine in Belgium in March 2016.

Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However conclusive data about reintubation are lacking. A nasal cannula is a device for delivering oxygen by way of two small tubes that are inserted into the nostrils.

In this study 264 patients received high-flow therapy and 263 conventional oxygen therapy. The primary outcome was reintubation within 72 hours, compared with Cochrane-Mantel-Haenszel X test. Secondary outcomes included postextubation respiratory failure, respiratory infection, sepsis and multiorgan failure, ICU and hospital length of stay and mortality, adverse events, and time to reintubation. According to the results, reintubation within 72 hours was less common in the high flow group (13 patients, or 5%) than in the conventional group (32 patients, or 12%). Postextubation respiratory failure was less common in the high-flow group (8%) than in the conventional group (14%). Time to reintubation was not significantly different between groups.

“The main finding of this study was that high-flow oxygen significantly reduced the reintubation rate in critically ill patients at low Risk for extubation failure,” the authors write.