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High-Flow Nasal Cannula versus Noninvasive Positive Pressure Ventilation in Patients with Heart Failure after Extubation: An Observational Cohort Study.
Can Respir J. 2020; 2020:6736475.CR

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.

Authors+Show Affiliations

Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32714476

Citation

Chang, Che-Jung, et al. "High-Flow Nasal Cannula Versus Noninvasive Positive Pressure Ventilation in Patients With Heart Failure After Extubation: an Observational Cohort Study." Canadian Respiratory Journal, vol. 2020, 2020, p. 6736475.
Chang CJ, Chiang LL, Chen KY, et al. High-Flow Nasal Cannula versus Noninvasive Positive Pressure Ventilation in Patients with Heart Failure after Extubation: An Observational Cohort Study. Can Respir J. 2020;2020:6736475.
Chang, C. J., Chiang, L. L., Chen, K. Y., Feng, P. H., Su, C. L., & Hsu, H. S. (2020). High-Flow Nasal Cannula versus Noninvasive Positive Pressure Ventilation in Patients with Heart Failure after Extubation: An Observational Cohort Study. Canadian Respiratory Journal, 2020, 6736475. https://doi.org/10.1155/2020/6736475
Chang CJ, et al. High-Flow Nasal Cannula Versus Noninvasive Positive Pressure Ventilation in Patients With Heart Failure After Extubation: an Observational Cohort Study. Can Respir J. 2020;2020:6736475. PubMed PMID: 32714476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-Flow Nasal Cannula versus Noninvasive Positive Pressure Ventilation in Patients with Heart Failure after Extubation: An Observational Cohort Study. AU - Chang,Che-Jung, AU - Chiang,Ling-Ling, AU - Chen,Kuan-Yuan, AU - Feng,Po-Hao, AU - Su,Chien-Ling, AU - Hsu,Han-Shui, Y1 - 2020/07/03/ PY - 2020/02/22/received PY - 2020/04/24/revised PY - 2020/05/06/accepted PY - 2020/7/28/entrez PY - 2020/7/28/pubmed PY - 2020/7/28/medline SP - 6736475 EP - 6736475 JF - Canadian respiratory journal JO - Can Respir J VL - 2020 N2 - 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. SN - 1916-7245 UR - https://www.unboundmedicine.com/medline/citation/32714476/High_Flow_Nasal_Cannula_versus_Noninvasive_Positive_Pressure_Ventilation_in_Patients_with_Heart_Failure_after_Extubation:_An_Observational_Cohort_Study_ L2 - https://doi.org/10.1155/2020/6736475 DB - PRIME DP - Unbound Medicine ER -