Protective mechanics for successful extubation in invasive mechanical ventilation. Literature review

Objectives: to know the effectiveness of alternative measures to Conventional Oxygen Therapy (COT) that have been proposed for the prevention of post-extubation complications in adult patients admitted to the Intensive Care Unit (ICU) and connected to Invasive Mechanical Ventilation (IMV) in the first 72 hours. Methods: Bibliographic searches were carried out in different search engines, highlighting PubMed and Cochrane. These searches were limited to clinical trials and systematic reviews published between 2016-2022. To assess the quality of the evidence, the CASPe and GRADE tools were used. Results: The High Flow Nasal Cannula (HFNC) and Non Invasive Mechanical Ventilation (NIMV) present an effectiveness in the prevention of reintubation against COT of RR 0.54 (CI 95% 0.32–0.89) and RR 0.55 (95% CI 0.30 - 1.00) respectively. Regarding post-extubation acute respiratory failure, the values ​​are RR 0.66 (95% CI 0.43 - 1.02) and RR 0.86 (95% CI 0.54 - 1.38), respectively. Conclusion: HFNC and NIMV are significantly superior to COT in preventing reintubation, having both similar effectiveness. On the other hand, HFNC is shown to be slightly superior to NIMV in the prevention of post-extubation acute respiratory failure. However, more research is required in the ICU setting.