Using NHF To
 Reduce The Risk Of Reintubation

 

New evidence continues to emerge showing how Optiflow™ Nasal High Flow
 contributes to improved patient care and outcomes.

Optiflow™ Nasal High Flow post extubation

In 1997, Epstein1 and colleagues examined patient outcomes associated with reintubation for extubation failure. They determined that patients who failed extubation had:

Where does Nasal High Flow fit in?

In previous editions we have shared the results of key studies by Frat3 and Maggiore4 demonstrating the efficacy of Optiflow™ in avoiding primary intubation as well as reintubation.

 

This study focused on patients deemed at low risk for reintubation and found a reduced risk of reintubation within 72 hours of extubation.

Collectively, these study findings provide a strong justification for the use of Optiflow™ Nasal High Flow both pre-intubation and post-extubation. Reducing the rates of primary intubation and reintubation could have profound impacts on clinical and economic outcomes in your hospital.

Although the primary outcome of the Frat study was not met, it was shown that for the more acute patients (with a PaO2:FiO2 ≤ 200 mmHg):

  • NHF significantly decreased the need for intubation : (35% of NHF patients compared to 53% standard O2 and 58% NIV)

Maggiore’s 2014 study investigated reintubation rates in a general population of critical care patients and found that:

  • NHF significantly decreased the need for reintubation: (4% of NHF patients compared to 21% in the venturi mask group)

Summary of HERNÁNDEZ ET AL. 2016

We are pleased to present a summary of the results of the Hernández5 study recently published in the Journal of the American Medical Association (JAMA). This study focused on patients deemed at low risk for reintubation and found a reduced risk of reintubation within 72 hours of extubation. 


Hernández and colleagues randomized 527 extubated patients at low risk of reintubation to receive nasal high flow (NHF) or conventional oxygen therapy for the first 24 hours after extubation. The study was carried out in seven ICU’s throughout Spain.

The use of Optiflow™ nasal high flow:

Optiflow™ reduces the risk of reintubation in low-risk patients, compared with conventional O2

Maggiore et al showed in 2014 that nasal high flow therapy after planned extubation decreased the reintubation rate in a general population of critical care patients.
However, it had been suggested that the results seen were attributable to improvements in the high-risk patients in this group. In their trial, Hernández et al focused specifically on low-risk patients, defined as:
  •  < 65 years of age
  •   APACHE II < 12
  •   BMI < 30
  • Adequate secretion clearance
  •   Simple weaning from MV
  •   Absence of heart failure  
  •   Comorbidities < 2

Results of this study

The primary outcome of the study was met. 527 patients were included and randomized to NHF (n=264) or standard oxygen therapy (n=263) (mean age 51.4 years, 62% male) with the following results:

 

  • Reduced risk of reintubation within 72 hours of extubation (NHF 4.9% vs. standard O2 12.2%, p=0.004)
  • Reduced rate of post-extubation respiratory failure (NHF 8.3% vs. conventional O2 14.4%, p=0.03)
  • No significant difference in median time to reintubation (NHF 19 h, conventional O2 15 h, p=0.66)
  • For every 14 patients treated with NHF, one reintubation was avoided (NNT = 14)

How does this study help clinicians and their patients?

This well-designed study provides compelling evidence that use of NHF immediately after planned extubation can reduce 72-hour reintubation rates in low-risk patients compared to conventional oxygen therapy.

These findings have significant implications not only on patient care, but also on costs of treatment. A secondary analysis of the patients who underwent reintubation showed increased ICU and hospital stays
compared to those successfully extubated.

Extubating each and every patient to Optiflow™ could provide a simple method to avoiding costly re-escalation of therapy

To discover how to integrate Optiflow™ NHF into your clinical practice, contact your local Fisher & Paykel Healthcare representative.

 Read the abstract
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References

  1. Epstein S, Ciubotaru R, Wong J. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997; 112: 186–192 
  2. Seymour CW, Martinez A, Christie JD, et al. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Crit Care. 2004; 8(5):322–327. 
  3. Frat JP, Thille AW, Mercat, et al. High-Flow Nasal Cannula Oxygen in Respiratory Failure. N Engl J Med. 2015; 372(23):2185-96. 
  4. Maggiore SM, Idone FA, Vaschetto R, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation: effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014; 190:282-288 
  5. Hernández G, Vaquero C, González P, et al. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA. 2016; 315(13):1354-61. 
  6. Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive positive airway presure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. JAMA. 2015; 313(23):2331-9.
  7. Kritek, P. Two Approaches to Lessen Need for Reintubation. Retrieved 10 May, 2016, from http://www.jwatch.org/na40798/2016/03/24/two-approaches-lessen-need-reintubation