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

Authors :
Kansal A
Dhanvijay S
Li A
Phua J
Cove ME
Ong WJD
Puah SH
Ng V
Tan QL
Manalansan JS
Zamora MSN
Vidanes MC
Sahagun JT
Taculod J
Tan AYH
Tay CK
Chia YW
Sewa DW
Chew M
Lew SJW
Goh S
Tan JJE
Ramanathan K
Mukhopadhyay A
See KC
Source :
Annals of the Academy of Medicine, Singapore [Ann Acad Med Singap] 2021 Jun; Vol. 50 (6), pp. 467-473.
Publication Year :
2021

Abstract

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.<br />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.<br />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).<br />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.

Details

Language :
English
ISSN :
2972-4066
Volume :
50
Issue :
6
Database :
MEDLINE
Journal :
Annals of the Academy of Medicine, Singapore
Publication Type :
Academic Journal
Accession number :
34195753
Full Text :
https://doi.org/10.47102/annals-acadmedsg.2020564