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Abstract
BACKGROUND: High-flow nasal cannula (HFNC) therapy may reduce the re-intubation rate compared with conventional oxygen therapy. However, HFNC has not been sufficiently compared with conventional oxygen therapy with a heated humidifier, even though heated humidification is beneficial for facilitating airway clearance.
METHODS: This study was a single-center, open-label, randomized controlled trial. We randomized subjects with respiratory failure after extubation to either HFNC group or to a large-volume humidified nebulization-based nebulizer. The primary end point was the re-intubation rate within 7 d after extubation.
RESULTS: We could not recruit enough subjects for the sample size we designed, therefore, we analyzed 69 subjects (HFNC group, 30 subjects; nebulizer group, 39 subjects). The re-intubation rate within 7 d was not significantly different between the HFNC and nebulizer groups (5/30 subjects [17%] and 6/39 subjects [15%], respectively; P > .99). 
/set 
at 24 h after extubation was also not significantly different between the respective groups (264 ± 105 mm Hg in the HFNC group vs 224 ± 53 mm Hg in the nebulizer group; P = .07).
CONCLUSIONS: Compared with a large-volume nebulization-based humidifier, HFNC may not reduce the re-intubation rate within 7 d. However, because of insufficient statistical power, further studies are needed to reach a conclusion.
- respiratory insufficiency
- respiratory therapy
- tracheal extubation
- weaning
- high-flow nasal cannula
- humidification
- ventilators
- oxygen inhalation therapy
- hypoxia
- re-intubation
Footnotes
- Correspondence: Wataru Matsuda MD, Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail: wmatsuda{at}hosp.ncgm.go.jp
Dr Matsuda presented a version of this paper at the 46th Annual Meeting of the Japanese Association for Acute Medicine held November 19, 2018, in Yokohama, Japan, and at the 46th Annual Meeting of the Japanese Society of Intensive Care Medicine held March 1, 2019, in Kyoto, Japan.
This study was supported in part by a Grant-in-Aid for Research from the National Center for Global Health and Medicine (29-2001). The funding source had no role in study design, the collection, analysis, or interpretation of data, or the preparation, review, or approval of the manuscript. We used this funding source only for manuscript preparation in English.
The authors have disclosed no conflicts of interest.
The basic information of this study have been registered on a registry University Hospital Medical Information Network Clinical Trials Registry (UMIN000019238).
- Copyright © 2020 by Daedalus Enterprises
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