Prognostic factors for extubation failure in high risk patients using high-flow nasal cannula

Paulina Ezcurra, M. Venuti, E. Gogniat, M. Ducrey, J. Dianti, A. Midley, S. Giannasi, E. S. Román, Nicolás Roux
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引用次数: 1

Abstract

Introduction: High flow nasal cannula (HFNC) is effective in preventing extubation respiratory failure in high risk patients. However there is a lack of information in which variables better predict which patients will not benefit from this intervention. Objective: Our goal is to identify variables that could predict which patients will not benefit with HFNC for extubation failure prevention. Methods: Prospective interventional single center study in an intensive care unit in Argentina. We included patients with at least one pre-specified risk factor who required invasive mechanical ventilation (IMV) for more than 48hs and passed a spontaneous breathing trial. HFNC was administered for the first 24hs following extubation. We divided extubation failure causes into those related with worsening of respiratory variables and non-respiratory related causes. Results: We include 165 patients. 40(24.2%) presented extubation failure, 18(10.9%) of which were for non-respiratory related causes and 22(13.3%) for worsening of respiratory variables. None of the pre-specified risk factors individually or combine between this were associated with extubation failure. The median of days of IMV prior to extubation was the only variable associated with extubation failure (5(3-6) vs 4(3-5), p=0.02) in the failure and success group respectively. Conclusions: Incidence of extubation failure in high risk patients receiving HFNC for extubation failure prevention was similar to that reported in previous trials. None of the pre-specified risk factors predicted extubation failure. Time of IMV prior to extubation was the only variable associated with extubation failure.
高危患者使用高流量鼻插管拔管失败的预后因素分析
高流量鼻插管(HFNC)是预防高危患者拔管呼吸衰竭的有效方法。然而,缺乏关于哪些变量能更好地预测哪些患者不会从这种干预中受益的信息。目的:我们的目标是确定变量,可以预测哪些患者不会受益于HFNC预防拔管失败。方法:对阿根廷某重症监护病房进行前瞻性单中心介入研究。我们纳入了至少有一种预先指定的危险因素,需要有创机械通气(IMV)超过48小时并通过自主呼吸试验的患者。拔管后24小时给予HFNC。我们将拔管失败的原因分为与呼吸变量恶化相关的原因和与呼吸无关的原因。结果:我们纳入了165例患者。其中拔管失败40例(24.2%),非呼吸相关原因18例(10.9%),呼吸变量恶化22例(13.3%)。所有预先指定的危险因素单独或联合与拔管失败无关。拔管前IMV天数中位数是拔管失败组和拔管成功组中唯一与拔管失败相关的变量(分别为5(3-6)vs 4(3-5), p=0.02)。结论:采用HFNC预防拔管失败的高危患者拔管失败发生率与既往试验报道相似。所有预先指定的危险因素都不能预测拔管失败。拔管前IMV时间是拔管失败的唯一变量。
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