A comparison of conventional high-flow nasal cannula vs the duet high-flow nasal cannula in extubated patients: a randomized crossover trial.

Abstract

Objectives: High-flow nasal cannulae (HFNC) are often used for oxygen delivery in intensive care units (ICU). A new configuration HNFC, the Duet HFNC, can deliver higher pressures and potentially improve gas exchange. The clinical performance, safety and patient comfort of these Duet cannula are unclear. Furthermore, there is no data on performance of conventional or Duet HFNC in patients with nasogastric tubes (NG) or between male and female patients. We compared the gas exchange, tolerance, and comfort with conventional and Duet HFNC.

Research methodology: This single-center, open labeled randomized crossover study included invasively ventilated patients who were extubated. Patients were randomized to protocol A (n = 25; Duet cannula for 30 min followed by conventional HFNC for 30 min) or protocol B (n = 25; conventional followed by Duet HFNC). Subgroup analysis included comparisons between patients with and without a NG, and between male and female patients when receiving Duet and conventional HFNC. During the study period the HFNCs flow rates were set at 40 L/min with the same FiO₂ standardizing the comparisons for both cannulas.

Results: There was no significant difference in PaO₂ (86.8 [22.2] vs. 88.9 [23.5]; p = 0.38), PaCO₂ (37.7 [3.9] vs. 37.8 [3.9]; p = 0.81) and SaO₂ (96.2% [2.0] vs. 96.4% [1.8]; p = 0.32), comfort and tolerance between the Duet and conventional HFNC. The subgroup analysis did not show a significant difference between these cannulas in patients with or without nasogastric tubes or between males and females.

Conclusion: Duet HFNC is comparable to conventional HFNC. Further studies on higher flow rates and for longer period are warranted to determine the utility of Duet cannula.

Clinical trial registration: This trial was registered with ClinicalTrials.gov (Number: NCT06398951) on 3rd May 2024- Retrospectively registered.