Table 1.
Comparison of patients treated with high-flow nasal oxygen alone and those treated with non-invasive ventilation (NIV) for post-extubation respiratory failure
| 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 |
P values indicated in bold were considered statistically significant (P < 0.05)
Continuous variables are given in mean ± standard deviation or median [interquartile range, IQR 25th–75th percentiles] according to their distribution
SAPS = Simplified Acute Physiology Score; SOFA = Sepsis-related Organ Failure Assessment; NIV = Non-Invasive Ventilation
aWeaning difficulty was defined as follows: simple weaning included patients extubated after success of the initial spontaneous breathing trial, difficult weaning included patients who failed the initial spontaneous breathing trial and were extubated within the 7 following days, and prolonged weaning included patients extubated more than 7 days after the initial spontaneous breathing trial