Survival effect of early high-flow nasal oxygen after the extubation of patients in the intensive care unit.

Abstract

Background: Reintubation of patients admitted to the intensive care unit (ICU) is associated with mortality risk during the clinical course. We aimed to investigate the survival effect of early high-flow nasal oxygen (HFNO) using the respiratory rate oxygenation (ROX) index cutoff point of 12.8 for early HFNO introduction following the extubation of patients in the ICU.

Methods: This study comprised 315 patients, divided into two groups: 159 patients admitted to the ICU from January 2021 to June 2022, before the establishment of the extubation criteria, and 156 patients admitted from July 2022 onwards, after the criteria were established. The exclusion criteria were death in the ICU, absence of extubation, and tracheotomy. We compared the HFNO reintubation rate and ROX index 2 h after extubation, before and after the establishment of early HFNO introduction criteria.

Results: The HFNO use rates before and after the application of the early HFNO criteria were not significantly different. However, the mortality rate significantly decreased following early HFNO use. Additionally, the period until the HFNO introduction was significantly different. The HFNO use rate within 2 h of extubation was significantly higher after the application of the early HFNO use criteria compared to before. Furthermore, significant differences were noted in the reintubation rate and length of ICU stay.

Conclusions: Early HFNO use after extubation in patients admitted to the ICU may reduce mortality and reintubation rate in the ICU. The ROX index is effective, can sensitively detect breathing changes, and is easy to implement.