1.Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study.
Amit KANSAL ; Shekhar DHANVIJAY ; Andrew LI ; Jason PHUA ; Matthew Edward COVE ; Wei Jun Dan ONG ; Ser Hon PUAH ; Vicky NG ; Qiao Li TAN ; Julipie Sumampong MANALANSAN ; Michael Sharey Nocon ZAMORA ; Michael Camba VIDANES ; Juliet Tolentino SAHAGUN ; Juvel TACULOD ; Addy Yong Hui TAN ; Chee Kiang TAY ; Yew Woon CHIA ; Duu Wen SEWA ; Meiying CHEW ; Sennen J W LEW ; Shirley GOH ; Jonathan Jit Ern TAN ; Kollengode RAMANATHAN ; Amartya MUKHOPADHYAY ; Kay Choong SEE
Annals of the Academy of Medicine, Singapore 2021;50(6):467-473
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 post-extubation 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,
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.
Adult
;
Airway Extubation
;
Cannula
;
Critical Care
;
Female
;
Humans
;
Intensive Care Units
;
Male
;
Middle Aged
;
Respiratory Insufficiency/therapy*
;
Singapore/epidemiology*
Result Analysis
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