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Publications

Journal Article Ahead of print 2 citations

PubMed: 42440109 DOI: 10.1007/s00134-026-08544-w

High-flow nasal cannula oxygen during breaks from noninvasive ventilation after extubation: an observational study.

Intensive Care Med

Authors: Arnaud W Thille, Louis Chamblet, Stéphanie Ragot, Arnaud Gacouin, Mai-Anh Nay, Stephan Ehrmann, Christophe Girault, Laurence Dangers, Guylaine Labro, Emmanuel Canet, Jean-Pierre Quenot, Maxens Decavele, Christophe Guitton, Gwenael Prat, Clément Saccheri, Damien Contou, Anahita Rouze, Marie-Ange Azais, Antoine Romen, Guillaume Lacave, Alexandre Lautrette, Nicholas Sedillot, Romain Sonneville, Emmanuel Vivier, Marie-Anne Hoppe, Jeremy Bourenne, François Beloncle, Rémi Coudroy, Jean-Pierre Frat

Affiliations

  • CHU de Poitiers, Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
  • CHU de Poitiers, INSERM CIC 1402 IS-ALIVE, Université de Poitiers, Poitiers, France.
  • CHU de Poitiers, INSERM CIC 1402 IS-ALIVE, Université de Poitiers, Poitiers, France.
  • CHU de Rennes, Hôpital Ponchaillou, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France.
  • CHU d'Orléans, Médecine Intensive Réanimation, Orléans, France.
  • CHU de Tours, Médecine Intensive Réanimation, Tours, France.
  • CIC INSERM 1415, Université de Tours, Tours, France.
  • CRICS-TriggerSEP F-CRIN Research Network, Tours, France.
  • Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France.
  • CHU de Rouen, Médecine Intensive Réanimation, Normandie Univ, UNIROUEN, GRHVN UR 3830, Rouen, France.
  • CHU Félix Guyon, Service de Réanimation Polyvalente, Saint Denis de la Réunion, France.
  • Groupement Hospitalier Régional Mulhouse et Sud Alsace, Service de Médecine Intensive Réanimation, Mulhouse, France.
  • CHU de Nantes, Médecine Intensive Réanimation, Nantes, France.
  • Université Bourgogne-Europe, CHU Dijon-Bourgogne, Service de Médecine Intensive-Réanimation, INSERM CIC-1432-Equipe Lipness UMR 1231, Dijon, France.
  • Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation (Département R3S), Paris, France.
  • Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
  • CH Le Mans, Médecine Intensive Réanimation, Le Mans, France.
  • CHU de Brest, Médecine Intensive Réanimation, Brest, France.
  • CHU de Nice, Médecine Intensive Ranimation, Nice, France.
  • CH d'Argenteuil, Médecine Intensive Réanimation, Argenteuil, France.
  • Université de Lille, CNRS, INSERM, CHU Lille, U1285 - UMR 8576 -UGSF -Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive Réanimation, Lille, France.
  • CH Départemental de Vendée, Médecine Intensive Réanimation, Roche-Sur-Yon, France.
  • CH de Pau, Service de Réanimation, Pau, France.
  • CH de Versailles, Médecine Intensive Réanimation, Le Chesnay, France.
  • CHU de Clermont-Ferrand, Médecine Intensive Réanimation, Clermont-Ferrand, France.
  • CH de Bourg-en-Bresse, Médecine Intensive Réanimation, Bourg-en-Bresse, France.
  • AP-HP, Hôpital Bichat, Médecine Intensive Réanimation, Paris, France.
  • Hôpital Saint Joseph - Saint Luc, Service de Réanimation, Lyon, France.
  • CH de La Rochelle, Médecine Intensive Réanimation, La Rochelle, France.
  • AP-HM, CHU La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, Marseille, France.
  • CHU d'Angers, Médecine Intensive Réanimation, Angers, France.
  • CHU de Poitiers, Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.

Abstract

PURPOSE

Clinical practice guidelines recommend prophylactic noninvasive ventilation (NIV) after extubation in high-risk patients. The effects of high-flow nasal cannula (HFNC) oxygen during breaks from NIV after extubation have been poorly explored. Our objective was to assess whether HFNC rather than standard oxygen during breaks from NIV may prevent extubation failure.

METHODS

Observational study based on two multicenter clinical trials including patients at high-risk of extubation failure (> 65 years or with underlying cardiac or respiratory disease). We included the 1077 patients who received prophylactic NIV after extubation, alternating with HFNC (NIV/HFNC) or standard oxygen (NIV/O 2). The primary outcome was the proportion of patients who failed extubation (reintubation or death within the seven days following extubation). We used G-computation to estimate the causal effect of HFNC on the risk of extubation failure, while accounting for confounding factors.

RESULTS

After extubation, 655 patients (61%) received NIV/HFNC while 422 (39%) received NIV/O 2. The extubation failure rate at day 7 was significantly lower with NIV/HFNC than with NIV/O 2 (13.7% vs. 18.5%; difference, - 4.7% [95% CI, - 9.4% to - 0.3%]; p = 0.036). Using G-computation, NIV/HFNC was not more effective than NIV/O 2 in reducing the risk of extubation failure, with an estimated adjusted difference of - 3.9% [95% CI, - 8.7% to 0.9%]. Reintubation rates were significantly lower with NIV/HFNC than with NIV/O 2 at 48h, but did not significantly differ beyond 48h.

CONCLUSIONS

Although the adjusted analysis did not confirm the favorable unadjusted findings, HFNC during breaks from NIV might decrease the risk of extubation failure, and warrants future clinical trials.

MeSH

Noninvasive Ventilation, Critical Care, Intensive Care Units, Ventilation, Cannula