Journal Article

Nasal High-Flow versus Venturi Mask Oxygen Therapy after Extubation. Effects on Oxygenation, Comfort, and Clinical Outcome

Festa, Rossano, Idone, Francesco Antonio, Cataldo, Andrea, Antonicelli, Federica, Navalesi, Paolo, Maggiore, Salvatore Maurizio, Vaschetto, Rosanna, Montini, Luca, Antonelli, Massimo, De Gaetano, Andrea

2014

Overview

Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. To compare the effects of the Venturi mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group. Compared with the Venturi mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).

• Publisher: American Thoracic Society,Oxford University Press
• Subject: Aged / Airway Extubation - instrumentation / Airway Extubation - methods / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Extubation / Female / Gas flow / Gases / Humans / Intensive care medicine / Intubation / Intubation, Intratracheal / Italy / Male / Masks - adverse effects / Masks - statistics & numerical data / Medical sciences / Middle Aged / Nose / Ostomy / Oxygen Inhalation Therapy - adverse effects / Oxygen Inhalation Therapy - instrumentation / Oxygen Inhalation Therapy - methods / Oxygen therapy / Patients / Pneumology / Respiratory Distress Syndrome, Adult - etiology / Respiratory Distress Syndrome, Adult - therapy / Ventilator Weaning - instrumentation / Ventilator Weaning - methods / Ventilators