scholarly journals Identifying predictive patients’ characteristics in case of High Flow Nasal Cannula failure when used for post-extubation failure

2019 ◽  
Author(s):  
Afra L.E. Terstappen ◽  
Lenneke E.M. Haas ◽  
Esther S.E. van Seumeren ◽  
Anja Balzereit ◽  
Henrik Endeman
Keyword(s):  
Kidney Injury ◽  
Extubation Failure ◽  
Primary Diagnosis ◽  
High Flow ◽  
Nasal Cannula ◽  
Secondary Outcome ◽  
Breathing Frequency ◽  
High Flow Nasal Cannula ◽  
Failure Group ◽  
Significant Difference

Abstract Background: High Flow Nasal Cannula (HFNC) is a relatively new but broadly used type of oxygen therapy. Hence, not much is known about HFNC in the setting of post-extubation failure. Aim of this study is to identify patients’ characteristics that predict failure of HFNC when used for post-extubation failure. Methods: This retrospective, observational study was conducted in a Dutch ICU. Between 2008 and 2014 all subjects aged 18 and older who started with HFNC due to respiratory failure within 2 to 72 hours after extubation were included. Primary outcome was patient characteristics predicting failure of HFNC. Failure was defined as reintubation or death following HFNC. Success was defined as the opportunity to stop HFNC after a non-specified time. Secondary outcome was the difference in length of stay (LOS) and mortality between the success and failure group. Results: A total of 246 subjects were included; in 135 (55%) cases HFNC failed. The success and failure group were comparable in terms of age, primary diagnosis and duration of mechanical ventilation prior to extubation. HFNC was started 19 ± 15 hours (mean ± SD) after extubation. Significant differences were found for breathing frequency (success: 22 ± 7/min vs. failure: 24 ± 7/min, p=0.009) and the presence of acute kidney injury (51% vs. 79%, p=0.003). There was a non-significant difference in pH (7.43 ± 0.07 vs. 7.40 ± 0.08, p=0.08). After logistic breathing frequency (p=0.02) and pH (p=0.01) remained independent predictors of HFNC failure. LOS at the ICU after starting HFNC differed (success: 181 ± 177 hours vs. failure: 405 ± 519 hours, p<0.001). ICU and hospital mortality were not significantly different between groups. Conclusion: In more than half of the patients HFNC failed when used for post-extubation failure. Breathing frequency and pH were predictors of HFNC failure.

scholarly journals Identifying predictive patients’ characteristics in case of High Flow Nasal Cannula failure when used for post-extubation failure

2020 ◽  
Author(s):  
Afra L.E. Terstappen ◽  
Lenneke E.M. Haas ◽  
Esther S.E. van Seumeren ◽  
Anja Balzereit ◽  
Henrik Endeman
Keyword(s):  
Kidney Injury ◽  
Extubation Failure ◽  
Primary Diagnosis ◽  
High Flow ◽  
Nasal Cannula ◽  
Secondary Outcome ◽  
Breathing Frequency ◽  
High Flow Nasal Cannula ◽  
Failure Group ◽  
Significant Difference

Abstract Background: High Flow Nasal Cannula (HFNC) is a relatively new but broadly used type of oxygen therapy. Hence, not much is known about HFNC in the setting of post-extubation failure. Aim of this study is to identify patients’ characteristics that predict failure of HFNC when used for post-extubation failure. Methods: This retrospective, observational study was conducted in a Dutch ICU. Between 2008 and 2014 all subjects aged 18 and older who started with HFNC due to respiratory failure within 2 to 72 hours after extubation were included. Primary outcome was patient characteristics predicting failure of HFNC. Failure was defined as reintubation or death following HFNC. Success was defined as the opportunity to stop HFNC after a non-specified time. Secondary outcome was the difference in length of stay (LOS) and mortality between the success and failure group. Results: A total of 246 subjects were included; in 135 (55%) cases HFNC failed. The success and failure group were comparable in terms of age, primary diagnosis and duration of mechanical ventilation prior to extubation. HFNC was started median 14 (min-max: 2-71) after extubation. Significant differences were found for breathing frequency (success: 21 (9-45)/min vs failure: 24(7-45)/min, p=0.009) and the presence of acute kidney injury (51% vs. 79%, p=0.003). There was a non-significant difference in pH pH (7.42(7.27-7.56) vs. 7.41 (7.13-7.58), p=0.08) After logistic breathing frequency (p=0.02) and pH (p=0.01) remained independent predictors of HFNC failure. LOS at the ICU after starting HFNC differed (success: median 131, min-max: 12-1432 hours vs. failure: 250 (23-4726) hours p<0.001. ICU and hospital mortality were not significantly different between groups. Conclusion: In more than half of the patients HFNC failed when used for post-extubation failure. Breathing frequency and pH were predictors of HFNC failure.

Readiness Assessment for Extubation Planning in the Intensive Care Unit: A Quality Improvement Initiative

2021 ◽  
Vol 41 (3) ◽  
pp. 42-48
Author(s):  
Jace D. Johnny
Keyword(s):  
High Risk ◽  
Failure Rate ◽  
Noninvasive Ventilation ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Prophylactic Measure ◽  
High Risk Patients ◽  
Risk Patients

Background Extubation failure is the reintubation of patients meeting criteria for weaning from mechanical ventilation. Extubation failure is correlated with mortality, prolonged mechanical ventilation, and longer hospital stays. Noninvasive ventilation or high-flow nasal cannula oxygen therapy after extubation is recommended to prevent extubation failure in high-risk patients. Local Problem The extubation failure rate is unknown. Prophylactic measures (noninvasive ventilation or high-flow nasal cannula) after extubation are not commonly used and vary among clinicians. The objective was to assess extubation planning readiness by determining extubation failure rate, identifying high-risk patients, and determining prophylactic measure compliance. Methods A quality improvement initiative included an evidence-based extubation failure risk assessment that identified high-risk patients and determined prophylactic measure compliance. A 2-year retrospective medical record review was used to determine baseline patient characteristics and extubation failure rate. Results Extubation failure rate within the retrospective cohort was 13 of 146 patients (8.9%). Extubation failure did not correlate with previously identified risk factors; however, 150 identified patients were excluded from analysis. During risk assessment integration, the extubation failure rate was 3 of 37 patients (8.1%) despite identifying 24 high-risk patients (65%). Few high-risk patients received prophylactic measures (noninvasive ventilation, 17%; high-flow nasal cannula, 12%). Conclusions Extubation failure should be routinely measured because of its effects on patient outcomes. This project reveals the multifactorial nature of extubation failure. Further research is needed to assess patients’ risk and account for acute conditions. This project used best practice guidelines for routine patient care and added transparency to a previously unmeasured event.

scholarly journals High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Wanru Geng ◽  
Wuliji Batu ◽  
Shuhong You ◽  
Zhaohui Tong ◽  
Hangyong He
Keyword(s):  
Respiratory Failure ◽  
Bronchial Asthma ◽  
Oxygen Therapy ◽  
Response Rate ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Therapy Technique ◽  
Significant Difference ◽  
Life Threatening

Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be life-threatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. The HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO2 and reduced PCO2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO2 and reduce HR and RR. Thus, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.

Prognostic factors for extubation failure in high risk patients using high-flow nasal cannula

2019 ◽  
Author(s):  
Paulina Ezcurra ◽  
María Sofia Venuti ◽  
Emiliano Gogniat ◽  
Marcela Ducrey ◽  
Jose Dianti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
High Risk Patients ◽  
Risk Patients

Heated Humidified High-Flow Nasal Cannula for Prevention of Extubation Failure in Preterm Infants

2017 ◽  
Vol 84 (4) ◽  
pp. 262-266 ◽  
Author(s):  
Sasivimon Soonsawad ◽  
Buranee Swatesutipun ◽  
Anchalee Limrungsikul ◽  
Pracha Nuntnarumit
Keyword(s):  
Preterm Infants ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

scholarly journals Efficacy of High-flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia

2021 ◽  
Author(s):  
Lingling Su ◽  
Qinyu Zhao ◽  
Taotao Liu ◽  
Yujun Xu ◽  
Weichun Li ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Medical Information ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
High Flow ◽  
Nasal Cannula ◽  
Intubation Rate ◽  
High Flow Nasal Cannula ◽  
Inpatient Hospitalization ◽  
Significant Difference

Abstract Objectives: To investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails.Methods: This retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45<PaCO2≤60 mmHg) received either HFNC or noninvasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan-Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality, 48-hour and 28-day intubation rates were compared using the Chi-square test. The predictive performances of HR/SpO2 and the ROX index (the ratio of SpO2/FiO2 to respiratory rate) at 4 hours were assessed regarding HFNC failure, which was determined if intubation was given within 48 hours after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO2 and the ROX index were calculated and compared.Results: A total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-hour intubation rate between the HFNC group and the NIV group (14.2% vs. 8.5%, P=0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, P=0.029), higher 28-day mortality (17.9% vs. 8.5%, P=0.043), longer ICU length of stay (4.4 vs. 3.3 days, P=0.019), compared to those of NIV group. The AUC of HR/SpO2 at 4 hours after the initiation of HFNC yielded around 0.660 for predicting 48-hour intubation, greater than that of the ROX index with an AUC of 0.589 (P<0.01).Conclusions: HFNC therapy cannot completely replace NIV for patients with mild hypercapnia. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO2 in predicting the failure of HFNC among these patients.

scholarly journals Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study

2021 ◽  
Vol 50 (6) ◽  
pp. 467-473
Author(s):  
Amit Kansal ◽  
Shekhar Dhanvijay ◽  
Andrew Li ◽  
Jason Phua ◽  
Matthew Edward Cove ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
Public Hospitals ◽  
Apache Ii Score ◽  
High Flow Nasal Cannula ◽  
Airway Extubation ◽  
Icu Length Of Stay

Introduction: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed postextubation HFNC. 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 following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic 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 score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83–3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median 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, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for 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

scholarly journals First Attempt at Using Electrical Impedance Tomography to Predict High Flow Nasal Cannula Therapy Outcomes at an Early Phase

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhe Li ◽  
Zhiyun Zhang ◽  
Qian Xia ◽  
Danling Xu ◽  
Shaojie Qin ◽  
...  
Keyword(s):  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Final Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Time To Failure ◽  
High Flow Nasal Cannula ◽  
Impedance Tomography ◽  
Rapid Shallow Breathing Index ◽  
Significant Difference

Objective: Spatial and temporal ventilation distributions in patients with acute respiratory failure during high flow nasal cannula (HFNC) therapy were previously studied with electrical impedance tomography (EIT). The aim of the study was to explore the possibility of predicting HFNC failure based on various EIT-derived parameters.Methods: High flow nasal cannula failure was defined reintubation within 48 h after HFNC. EIT was performed with the patients spontaneously breathing in the supine position at the start of HFNC. EIT-based indices (comprising the global inhomogeneity index, center of ventilation, ventilation delay, rapid shallow breathing index, minute volume, and inspiration to expiration time) were explored and evaluated at three time points (prior to HFNC, T1; 30 min after HFNC started, T2; and 1 h after, T3).Results: A total of 46 subjects were included in the final analysis. Eleven subjects had failed HFNC. The time to failure was 27.8 ± 12.4 h. The ROX index (defined as SpO2/FiO2/respiratory rate) for HFNC success patients was 8.3 ± 2.7 and for HFNC failure patients, 6.2 ± 1.8 (p = 0.23). None of the investigated EIT-based parameters showed significant differences between subjects with HFNC failure and success. Further subgroup analysis indicated that a significant difference in ventilation inhomogeneity was found between ARDS and non-ARDS [0.54 (0.37) vs. 0.46 (0.28) as evaluated with GI, p &lt; 0.01]. Ventilation homogeneity significantly improved in ARDS after 60-min HFNC treatment [0.59 (0.20) vs 0.57 (0.19), T1 vs. T3, p &lt; 0.05].Conclusion: Spatial and temporal ventilation distributions were slightly but insignificantly different between the HFNC success and failure groups. HFNC failure could not be predicted by changes in EIT temporal and spatial indexes of ventilation distribution within the first hour. Further studies are required to predict the outcomes of HFNC.

scholarly journals Efficacy and Safety of Heated humidified high-flow nasal cannula for Preventing Extubation Failure in Neonates: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Jia Liu ◽  
Hongyan Qiu ◽  
Baihua Zheng ◽  
Lu Jin ◽  
Jing Chen
Keyword(s):  
Meta Analysis ◽  
Extubation Failure ◽  
Incidence Rates ◽  
High Flow ◽  
Nasal Cannula ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
High Flow Nasal Cannula ◽  
Nasal Trauma

Abstract Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a meta-analysis examining the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) for infants. Methods: Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to December 2020. Only randomized controlled trials (RCTs) of HHHFNC versus NCPAP in preventing extubation failure for infants were included. Results: A total of 13 RCTs research literatures involving 2395 infants were included in the Meta-analysis. The meta-analysis showed the following results. (1) In terms of efficacy, there were no significant differences between two groups in the treatment failure rate (RR: 1.00, 95%CI: 0.73 to 1.36, P=0.99) and reintubation rate (RR: 0.86, 95%CI: 0.70 to 1.06, P=0.16). While in term of safety, HHHFNC had a significant advantage over NCPAP in reducing the incidence rates of nasal trauma (RR: 0.27, 95%CI: 0.13 to 0.56, P=0.0005) and frequent hemorrhoid (RR: 0.40, 95%CI: 0.23 to 0.70, P=0.001).(2) In terms of secondary outcome measures, there were no significant differences between two groups in hospital mortality rate and incidence rates of BPD, ROP, IVH and duration of reaching full enteral feeding(P>0.05). HHHFNC demonstrated lower incidence of NEC (RR: 0.65, 95%CI: 0.43 to 0.98, P=0.04) than NCPAP. Conclusion:this meta-analysis showed that HHHFNC appears to be similar to NCPAP in efficacy of preventing extubation failure in infants. It is associated with significantly lower odds of nasal trauma, frequent hemorrhoid and NEC.

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