Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation in High-Risk Patients
Hernandez 2016 trial design and results
Design
Multicentre randomised non-inferiority trial
Treatment
High-flow nasal oxygen after extubation
Control
Non-invasive ventilation after extubation
Population
604 patients at high risk of extubation failure, mean age 65, 64% men
Follow-up
ICU and hospital stay
Primary endpoint
Reintubation and post-extubation respiratory failure within 72 hours
Result
Reintubation occurred in 66 of 290 (22.8%) with high-flow oxygen versus 60 of 314 (19.1%) with non-invasive ventilation, meeting non-inferiority. Post-extubation respiratory failure occurred in 78 (26.9%) versus 125 (39.8%). Median ICU stay after randomisation was shorter with high-flow oxygen, 3 versus 4 days (p=0.048). Adverse effects requiring withdrawal of therapy occurred in none of the high-flow group versus 42.9% of the non-invasive ventilation group (p<0.001).
Secondary endpoints
Time to reintubation, ICU length of stay, adverse effects
Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients.
The trial authors, in the published abstract
How it has aged
Established high-flow oxygen as the default post-extubation support for high-risk patients: equivalent reintubation, less respiratory failure, shorter stay, and far more comfortable. Thille 2019 later showed that adding non-invasive ventilation on top of high-flow does help the highest-risk group.
Publications
Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial
Hernández G, Vaquero C, Colinas L, et al. Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA 2016 Oct 18;316(15):1565-1574.
Non-inferior reintubation rate versus non-invasive ventilation