Late Breaking Abstract - The efficacy of heated humidifier high-flow nasal cannula compared with noninvasive positive-pressure ventilation in prevention of reintubation in patients with prolonged mechanical ventilation

Introduction: The purpose of this study is to assess the efficacy of high-flow nasal cannula (HFNC) compared with non-invasive positive pressure ventilation (NPPV) in prevention of extubation failure in patients with prolonged mechanical ventilation. Methods: This is a prospective, randomized control, single center, clinical trial. Patients who were prolonged mechanically ventilated (>14 days) had been transferred to stepdown unit for weaning. A total of 40 patients were enrolled in our study. After extubation, patients were randomly assigned to HFNC or NPPV treatment group. The major clinical outcomes measured were re-intubation rate, in hospital mortality and length of non-invasive ventilation time after extubation. Patient who had neuromuscular disorders, central respiratory drive disorders, tracheostomy and signed “do not resuscitate” were excluded. Results: The reintubation rate was significantly higher in HFNC group (NPPV 0% vs. HFNC 25%, p =.008), the length of NPPV support after extubation was shorter in NPPV group compared to HFNC group (NPPV 13-hrs vs. HFNC 20-hrs, p =.001). The physiologic variables at one hour after extubation, including PaO2/FiO2, PaCO2, were significantly improved in NPPV group than HFNC group. However, there were no diference in length of hospital stay and mortality. Conclusion: Compared with NPPV, HFNC has higher reintubation rate than NPPV. Our study demonstrated that for those patients who were prolonged mechanically ventilated, NPPV should be applied rather than HFNC after extubation to reduce the extubation failure.