Background
Methods
Study design and patients
Treatment groups
Outcomes
Statistical analysis
Result
High-flow nasal oxygen (n = 62) | Non-invasive ventilation (n = 84) | P value | |
---|---|---|---|
Characteristics of the patients at admission | |||
Age, years | 71 ± 9 | 70 ± 9 | 0.59 |
Male sex, n (%) | 40 (65%) | 53 (63%) | 0.86 |
Body-mass index, kg/m2 | 29 ± 7 | 28 ± 7 | 0.91 |
SAPS II at admission, points | 60 ± 18 | 56 ± 17 | 0.22 |
Underlying chronic cardiac disease, n (%) | 27 (44%) | 38 (45%) | 0.84 |
Underlying chronic lung disease, n (%) | 23 (37%) | 34 (40%) | 0.68 |
Chronic obstructive pulmonary disease, n (%) | 18 (29%) | 25 (30%) | 0.92 |
Acute respiratory failure as reason for intubation, n (%) | 35 (56%) | 54 (64%) | 0.34 |
Characteristics of the patients the day of extubation | |||
SOFA score, points | 4.5 ± 2.7 | 4.4 ± 2.8 | 0.84 |
Duration of mechanical ventilation, median (IQR), days | 5 [3–11] | 6 [4–10] | 0.71 |
Weaning difficultya, n (%) | 0.20 | ||
-Simple weaning | 36 (58%) | 49 (58%) | |
-Difficult or prolonged weaning | 26 (42%) | 35 (42%) | |
Ineffective cough, n/n total (%) | 15/58 (26%) | 31/82 (38%) | 0,14 |
Abundant secretions, n/n total (%) | 30/57 (53%) | 32/83 (39%) | 0,10 |
Administration of steroids before extubation, n (%) | 4 (6%) | 13 (15%) | 0,09 |
Prophylactic NIV after extubation, n (%) | 7 (11%) | 56 (67%) | < 0.001 |
Characteristics at time of respiratory failure | |||
Interval between extubation and respiratory failure, hours | 20 [5–47] | 22 [4–57] | 0.89 |
Systolic arterial pressure, mm Hg | 136 ± 21 | 135 ± 26 | 0.82 |
Diastolic arterial pressure, mm Hg | 67 ± 13 | 66 ± 16 | 0.68 |
Heart rate, beats/min | 90 ± 28 | 87 ± 35 | 0.58 |
Respiratory rate, breaths/min | 27 [23–33] | 30 [25–37] | 0.07 |
Clinical signs suggesting respiratory distress, n (%) | 20 (32%) | 33 (39%) | 0.38 |
SpO2, % | 94 ± 7 | 95 ± 4 | 0.40 |
PaO2, mm Hg | 83 ± 39 | 80 ± 24 | 0.66 |
PaO2/FiO2, mm Hg | 181 ± 72 | 187 ± 76 | 0.70 |
pH, units | 7.46 ± 0.06 | 7.41 ± 0.10 | < 0.01 |
PaCO2, mm Hg | 41 ± 9 | 48 ± 17 | < 0.01 |
Hypercapnia (PaCO2 > 45 mm Hg), n/n total (%) | 13/50 (26%) | 33/73 (45%) | 0.03 |
Treatment duration between the onset of respiratory failure and recovery or reintubation, hours | |||
Duration of high-flow nasal oxygen, hours | 14 [2–54] | 10 [1–33] | 0.04 |
Duration of NIV, hours | 0 [0–0] | 12 [4–27] | < 0.001 |
Primary outcome
High-flow nasal oxygen (n = 62) | Non-invasive ventilation (n = 84) | Absolute difference, % (95% CI) | P value | |
---|---|---|---|---|
Primary outcome | ||||
Mortality at day 28, n (%) | 18 (29%) | 15 (18%) | − 11 (− 25 to 2) | 0.11 |
Secondary outcomes | ||||
Reintubation at 48 h, n (%) | 32 (52%) | 37 (44%) | − 7 (− 23 to 9) | 0.37 |
Reintubation up until ICU discharge, n (%) | 35 (56%) | 40 (48%) | − 9 (− 24 to 7) | 0.29 |
Mortality of reintubated patients, n (%) | 11/35 (31%) | 12/40 (30%) | − 1 (− 22 to 19) | 0.89 |
Interval between the onset of respiratory failure and reintubation, hours | 3.0 [1.3–10.5] | 5.1 [1.8–18.0] | – | 0.17 |
Length of stay in ICU, days | 8 [4–14] | 8 [5–17] | – | 0.48 |
Mortality in ICU, n (%) | 14 (23%) | 16 (19%) | − 4 (− 17 to 9) | 0.60 |
Mortality at day 90, n (%) | 24 (39%) | 26 (31%) | − 8 (− 23 to 8) | 0.33 |
Secondary outcomes
No reintubation (n = 71) | Reintubation (n = 75) | P value | |
---|---|---|---|
Characteristics of the patients at admission | |||
Age, years | 72 ± 9 | 69 ± 9 | 0.049 |
Male sex, n (%) | 40 (56%) | 53 (71%) | 0.07 |
Body-mass index, kg/m2 | 30 ± 8 | 27 ± 6 | 0.02 |
Obesity, n (%) | 30 (43%) | 20 (27%) | 0.04 |
SAPS II at admission, points | 58 ± 18 | 57 ± 18 | 0.86 |
Underlying chronic cardiac disease, n (%) | 33 (46%) | 32 (43%) | 0.64 |
Underlying chronic lung disease, n (%) | 29 (41%) | 28 (37%) | 0.66 |
Acute respiratory failure as reason for intubation, n (%) | 43 (61%) | 46 (61%) | 0.92 |
Characteristics of the patients the day of extubation | |||
SOFA score, points | 4.1 ± 2.8 | 4.8 ± 2.7 | 0.11 |
Duration of mechanical ventilation, median (IQR), days | 6 [3–13] | 6 [3–13] | 0.85 |
Weaning difficulty, n (%) | 0.20 | ||
Simple weaning | 36 (51%) | 49 (65%) | |
Difficult or prolonged weaning | 35 (49%) | 26 (35%) | |
Ineffective cough, n/n total (%) | 25/67 (37%) | 21/73 (29%) | 0.28 |
Abundant secretions, n/n total (%) | 24/68 (35%) | 38/72 (53%) | 0.04 |
Administration of steroids before extubation, n (%) | 12 (17%) | 5 (7%) | 0.05 |
Prophylactic NIV after extubation, n (%) | 32 (45%) | 31 (41%) | 0.65 |
Characteristics at time of ARF | |||
Interval between extubation and respiratory failure, hours | 20 [5–47] | 22 [4–57] | 0.89 |
Systolic arterial pressure, mm Hg | 135 ± 25 | 136 ± 24 | 0.67 |
Diastolic arterial pressure, mm Hg | 66 ± 14 | 67 ± 15 | 0.94 |
Heart rate, beats/min | 82 ± 33 | 95 ± 30 | 0.01 |
Respiratory rate, breaths/min | 39 ± 25 | 35 ± 22 | 0.38 |
Clinical signs suggesting respiratory distress, n (%) | 38 (54%) | 15 (20%) | < 0.001 |
SpO2, % | 95 ± 4 | 94 ± 7 | 0.47 |
PaO2, mm Hg | 83 ± 26 | 80 ± 36 | 0.59 |
PaO2/FiO2, mm Hg | 196 ± 76 | 175 ± 72 | 0.18 |
pH, units | 7,42 ± 0,08 | 7,44 ± 0,09 | 0.38 |
PaCO2, mm Hg | 47 ± 13 | 43 ± 15 | 0.09 |
Hypercapnia (PaCO2 > 45 mm Hg), n/n total (%) | 29/62 (47%) | 17/61 (28%) | 0.03 |
Treatment of respiratory failure | |||
Use of curative non-invasive ventilation, n (%) | 44 (61%) | 40 (53%) | 0.29 |
Duration of administered treatment, hours | 57 [28–86] | 5 [2–16] | < 0.001 |
Duration of curative high-flow nasal oxygen hours | 38 [16–72] | 3 [1–10] | < 0.001 |
Duration of curative NIV, hours | 10 [0–27] | 2 [0–7] | 0.002 |