The following is a summary of the “Direct Extubation to High-Flow Nasal Cannula versus Noninvasive Ventilation in Obese Subjects,” published in the February 2023 issue of Respiratory Care by Magdy, et al.

After extubation, acute respiratory failure in the intensive care unit is more likely to occur in morbidly obese patients. To see if high-flow nasal cannula (HFNC) can help reduce post-extubation respiratory failure and the re-intubation rate, this study compared the extubation of critically ill and obese subjects to HFNC vs. noninvasive ventilation (NIV).

Obese subjects (BMI 30 kg/m2) in this randomized controlled trial were randomly assigned to receive HFNC (n = 60), or NIV applied immediately after extubation (n = 60). The primary outcomes of interest were the incidence of respiratory failure after extubation and the re-intubation rate within 72 hours. Oxygen saturation, respiratory rate, subjective dyspnea, length of intensive care unit (ICU) and hospital stay, and 28-day ICU mortality were secondary outcomes.

Compared to NIV, HFNC reduced the risk of respiratory failure by 8.4 percentage points, with a 95% CI of 6.2 to 12.8. Re-intubation was less common in the HFNC group than in the NIV group, but the difference was not statistically significant (11.6% vs. 16.6%; difference 5%, 95% CI 2.6% to 8.2%). The mean Pa_O2/FI_O2 increased significantly in the HFNC group compared to the NIV group in 48-hour intervals and 72 hours post-extubation. By 72 hours after being extubated, both groups exhibited similarly low levels of dyspnea. 

There was no noticeable difference in breathing rate between the groups. ICU and overall hospital stay times were also similar between the 2 groups. Hospital mortality rates were similar between the HFNC and NIV groups. The presence of severe obesity, comorbidities, a higher severity score, and hypercapnia remained associated with an increased risk of re-intubation, as determined by multivariable logistic regression analysis. The use of HFNC after extubation has the potential to protect obese patients from developing respiratory failure.

Source: rc.rcjournal.com/content/68/2/234