Timely identification of patients at high risk of extubation failure and implementation of appropriate strategies to prevent post-extubation respiratory failure is a crucial issue for ICU (Intensive Care Unit) physicians (1).
International guidelines suggest that Noninvasive Ventilation (NIV) should be used to prevent post-extubation respiratory failure in high-risk patients (2). Furthermore, a recent Randomized Control Trial (RCT) from Hernandez et al. (3) showed that High-Flow Nasal Oxygen (HFNO) is not non-inferior to NIV in preventing re-intubation at 72 hours in patients at high-risk of intubation.
The recent study conducted by Thille et al. examined the best strategy to reduce the risk of re-intubation among high-risk mechanically ventilated patients, comparing two treatment strategies: HFNO + NIV (PS 8±2, PEEP 5±1; first NIV session for > 4h and at least 12 h/day for 48h) and HFNO alone (flow of 50 L/min and FiO2 adjusted for SpO2 > 92%; at least for 48h).
In this multicenter RCT conducted at 30 ICUs in France, 648 adult patients intubated for > 24h and at high risk of extubation failure (> 65 years or with underlying chronic lung or cardiac diseases) were randomized to HFNO + NIV (n = 342) or HFNO alone (n = 306), immediately after extubation. Patients were stratified on PaCO2 level >45 mmHg.
The primary outcome was re-intubation at 7 days; secondary outcomes included post-extubation respiratory failure at day 7, re-intubation rates up until ICU discharge and ICU mortality.
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