In:
Annals of the Academy of Medicine, Singapore, Academy of Medicine, Singapore, Vol. 50, No. 6 ( 2021-6-30), p. 467-473
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 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
Type of Medium:
Online Resource
ISSN:
0304-4602
DOI:
10.47102/annals-acadmedsg.
DOI:
10.47102/annals-acadmedsg.2020564
Language:
English
Publisher:
Academy of Medicine, Singapore
Publication Date:
2021
detail.hit.zdb_id:
2186627-2
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