Wataru Matsuda1, Akiyoshi Hagiwara2, Tatsuki Uemura3, Takunori Sato3, Kentaro Kobayashi3, Ryo Sasaki3, Tatsuya Okamoto4, Akio Kimura3. 1. Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan. wmatsuda@hosp.ncgm.go.jp. 2. Department of Emergency Medicine, Niizashiki Chuo General Hospital, Niiza-shi, Saitama, Japan. 3. Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan. 4. Department of Intensive Care Medicine, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
Abstract
BACKGROUND:High-flow nasal cannula (HFNC) therapy may reduce the re-intubation rate compared with conventional oxygen therapy. However, HFNC has not been sufficiently compared with conventional oxygen therapy with a heated humidifier, even though heated humidification is beneficial for facilitating airway clearance. METHODS: This study was a single-center, open-label, randomized controlled trial. We randomized subjects with respiratory failure after extubation to either HFNC group or to a large-volume humidified nebulization-based nebulizer. The primary end point was the re-intubation rate within 7 d after extubation. RESULTS: We could not recruit enough subjects for the sample size we designed, therefore, we analyzed 69 subjects (HFNC group, 30 subjects; nebulizer group, 39 subjects). The re-intubation rate within 7 d was not significantly different between the HFNC and nebulizer groups (5/30 subjects [17%] and 6/39 subjects [15%], respectively; P > .99). [Formula: see text]/set [Formula: see text] at 24 h after extubation was also not significantly different between the respective groups (264 ± 105 mm Hg in the HFNC group vs 224 ± 53 mm Hg in the nebulizer group; P = .07). CONCLUSIONS: Compared with a large-volume nebulization-based humidifier, HFNC may not reduce the re-intubation rate within 7 d. However, because of insufficient statistical power, further studies are needed to reach a conclusion.
RCT Entities:
BACKGROUND: High-flow nasal cannula (HFNC) therapy may reduce the re-intubation rate compared with conventional oxygen therapy. However, HFNC has not been sufficiently compared with conventional oxygen therapy with a heated humidifier, even though heated humidification is beneficial for facilitating airway clearance. METHODS: This study was a single-center, open-label, randomized controlled trial. We randomized subjects with respiratory failure after extubation to either HFNC group or to a large-volume humidified nebulization-based nebulizer. The primary end point was the re-intubation rate within 7 d after extubation. RESULTS: We could not recruit enough subjects for the sample size we designed, therefore, we analyzed 69 subjects (HFNC group, 30 subjects; nebulizer group, 39 subjects). The re-intubation rate within 7 d was not significantly different between the HFNC and nebulizer groups (5/30 subjects [17%] and 6/39 subjects [15%], respectively; P > .99). [Formula: see text]/set [Formula: see text] at 24 h after extubation was also not significantly different between the respective groups (264 ± 105 mm Hg in the HFNC group vs 224 ± 53 mm Hg in the nebulizer group; P = .07). CONCLUSIONS: Compared with a large-volume nebulization-based humidifier, HFNC may not reduce the re-intubation rate within 7 d. However, because of insufficient statistical power, further studies are needed to reach a conclusion.
Authors: Andrew J E Seely; Bram Rochwerg; Shannon M Fernando; Alexandre Tran; Behnam Sadeghirad; Karen E A Burns; Eddy Fan; Daniel Brodie; Laveena Munshi; Ewan C Goligher; Deborah J Cook; Robert A Fowler; Margaret S Herridge; Pierre Cardinal; Samir Jaber; Morten Hylander Møller; Arnaud W Thille; Niall D Ferguson; Arthur S Slutsky; Laurent J Brochard Journal: Intensive Care Med Date: 2021-11-25 Impact factor: 17.440
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