Abstract
Noninvasive positive pressure ventilation (NPPV) has been widely applied in patients with high-risk extubation failure, including heart failure. High-flow nasal cannula (HFNC) has been demonstrated to benefit patients with heart failure by reducing cardiac preload. This study aimed to compare the effectiveness of HFNC to NPPV for preventing extubation failure in patients with heart failure. This 3-year retrospective and single-center cohort study included patients with heart failure with left ventricular ejection fraction <50% who received prophylactic HFNC or NPPV after scheduled extubation from January 2015 to January 2018 from a medical center with four adult intensive care units. Demographics, comorbidities, diagnosis, and weaning status were collected. The primary outcome was treatment failure within 72 hours after extubation, which was defined as escalation to NPPV or reintubation in the HFNC group and was defined as requiring reintubation in the NPPV group. Secondary outcomes were reintubation within 72 hours, reintubation, duration of stay, and mortality during the intensive care unit and hospital stay. Of the 104 patients analyzed, characteristics of 58 patients in the HFNC group and 46 patients in the NPPV group were compared. The treatment failure within 72 hours in the two groups was not significantly different (25.9% vs 13%, p=0.106). Hypoxemic respiratory failure related treatment failure was significantly higher in the HFNC group. Prophylactic HFNC as first-line therapy had a comparable rate of reintubation within 72 hours to the prophylactic NPPV alone (17.2% vs 13%, p=0.556). Other secondary outcomes were similar between the two groups. Among patients with heart failure, HFNC was not inferior to NPPV for preventing extubation failure and reintubation. However, in case of an impending respiratory failure, selective patients may benefit from rescue NPPV.
Highlights
Noninvasive positive pressure ventilation (NPPV) has been widely applied in patients with high-risk extubation failure, including heart failure
In case of an impending respiratory failure, selective patients may benefit from rescue NPPV
We reviewed a total of 5,497 intensive care units (ICUs) patients who had received mechanical ventilation (MV) for tracheal intubation and included 134 patients according to the following criteria: patients (1) who were on mechanical ventilator with endotracheal tube for more than 24 h, (2) who passed the weaning readiness assessment, (3) who had first episode of extubation, (4) who had heart failure with left ventricular ejection fracture (LVEF)
Summary
Noninvasive positive pressure ventilation (NPPV) has been widely applied in patients with high-risk extubation failure, including heart failure. Is study aimed to compare the effectiveness of HFNC to NPPV for preventing extubation failure in patients with heart failure. End positive airway pressure (EPAP) is used for noninvasive ventilation and generates hemodynamic effects in cases of heart failure, similar to continuous positive airway pressure (CPAP) delivered by a face mask [7], which increases cardiac performance and stroke volume in patients with heart failure and a high left ventricular filling pressure [8,9,10]. Two noninvasive respiratory devices can generate positive pressure during the expiratory phase and have been used to prevent extubation failure, namely, high-flow nasal cannula (HFNC) and noninvasive positive pressure ventilation (NPPV). HFNC could relieve dyspnea and hypoxemia in cardiogenic pulmonary edema [13, 14]
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