Open AccessPredictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study
Author(s) -
Amit Kansal,
Shekhar Dhanvijay,
Andrew Li,
Jason Phua,
Matthew E. Cove,
Wei Jun Dan Ong,
Ser Hon Puah,
Vicky Ng,
Qiao Li Tan,
Julipie Sumampong Manalansan,
Michael Sharey Nocon Zamora,
Michael Camba Vidanes,
Juliet Sahagun,
Juvel Taculod,
Addy Tan,
Cho Jui Tay,
Yew Woon Chia,
Duu Wen Sewa,
Meiying Chew,
Sennen Jin Wen Lew,
Shirley Goh,
Jonathan Tan,
Kollengode Ramanathan,
Amartya Mukhopadhyay,
Kay Choong See
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2020564
Subject(s) - medicine , nasal cannula , odds ratio , intubation , confidence interval , observational study , anesthesia , intensive care , intensive care unit , hypercapnia , emergency medicine , intensive care medicine , surgery , cannula , acidosis
Despite adhering to criteria for extubation, up to 20% of intensive care patients requirere-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims toidentify independent predictors and outcomes of extubation failure in patients who failed postextubationHFNC.Methods: We conducted a multicentre observational study involving 9 adult intensive care units(ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC followingspontaneous breathing trials. We compared patients who were successfully weaned off HFNC withthose who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additivelogistic regression analysis was used to identify independent risk factors for failed HFNC.Results: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primaryreasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidenceinterval 1.83–3.37). Failed HFNC, as compared to successful HFNC, was associated with increasedmedian ICU length of stay (14 versus 7 days, P<0.001), ICU mortality (14.6% versus 2.0%, P<0.001)and hospital mortality (29.3% versus 12.3%, P=0.006).Conclusion: Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remainsa clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the needfor future prospective trials to better identify patients at high risk of post-extubation HFNC failure.Keywords: Adult, airway extubation, high-flow nasal cannula, mechanical ventilation, respiratory failure