Noninvasive Ventilation Versus High-Flow Nasal Cannula After Extubation in High-Risk ICU Patients

Benha University102 enrolled

Overview

Extubation failure is associated with increased morbidity and mortality in critically ill patients. High-risk patients may benefit from preventive respiratory support after extubation. This randomized controlled trial compared noninvasive ventilation (NIV) with high-flow nasal cannula (HFNC) in adult intensive care unit (ICU) patients at high risk of extubation failure. The study evaluated reintubation rates, time to reintubation, physiological parameters, complications, and clinical outcomes following planned extubation. The aim was to determine the optimal post-extubation respiratory support strategy for reducing extubation failure in high-risk ICU patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

102

Conditions

Extubation Failure

Interventions

NIV was initiated immediately after extubation using bilevel positive airway pressure delivered via a properly fitted face mask with active humidification using a Dräger Savina 300 ventilator (Drägerwerk AG \& Co. KGaA, Lübeck, Germany). Ventilator settings were adjusted to achieve a respiratory rate \<26 breaths/min, tidal volume of 6-8 mL/kg predicted body weight, and adequate oxygenation (SpO₂ ≥92%, pH ≥7.35). Sedation was not permitted.

HFNCDEVICE

HFNC was applied immediately after extubation using a heated humidified high-flow nasal cannula system (BioVent A-Series, Model: BioHF BB60101; BIO-AOI, Cairo, Egypt). Flow was initially set at 10 L/min and titrated up to 60 L/min according to patient tolerance. Gas temperature was maintained at 37°C. In both groups, FiO₂ was adjusted to maintain SpO₂ ≥92%. After 48 hours, respiratory support was discontinued and conventional oxygen therapy was provided if required. Rescue NIV was not allowed in the HFNC group. All patients received standardized care.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

inclusion criteria 1. Age ≥18 years. 2. Received invasive mechanical ventilation for at least 24 hours. 3. Considered ready for planned extubation after successful completion of a spontaneous breathing trial. 4. High risk of extubation failure, defined by the presence of at least four of the following risk factors: Age \>65 years. APACHE II score \>12 on the day of extubation. Body mass index \>30 kg/m². Inadequate secretion management. Difficult or prolonged weaning. Two or more comorbidities. Acute heart failure requiring mechanical ventilation. Moderate-to-severe chronic obstructive pulmonary disease. Airway patency problems. Prolonged mechanical ventilation. Hypercapnia at the end of the spontaneous breathing trial. Exclusion Criteria: 1. Age \<18 years. 2. Presence of a tracheostomy. 3. Accidental extubation. 4. Self-extubation. 5. Contraindication to noninvasive ventilation.

Outcomes

Primary Outcomes

Reintubation Rate

Proportion of patients requiring reintubation following planned extubation.

Time frame: 7 days

Secondary Outcomes

Time to Reintubation

Time elapsed from extubation to reintubation among patients requiring reintubation.