Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
J Crit Care. 2021 Jun;63:117-123. doi: 10.1016/j.jcrc.2020.09.031. Epub 2020 Sep 28.
Compare the efficacy(reintubation rate) between a high-flow nasal cannula(HFNC) and the WhisperFlow CPAP system in patients at risk for postextubation failure.
RCT was conducted in patients who had at least one high-risk criterion for postextubation failure. All patients were randomly assigned to CPAP or HFNC for 48 h.
Of 140 patients, sixty-nine were assigned to the CPAP group and 71 to the HFNC group. The reintubation rate was similar between the HFNC and WhisperFlowCPAP [5 cases(7.0%) vs. 6 cases(8.7%); P = 0.76]. The postextubation respiratory failure rate was not significantly different between the HFNC and WhisperFlow CPAP groups [10 cases(14.1%)vs.7cases(10.1%); P = 0.48]. The respiratory rate was lower in the HFNC than CPAP group(P = 0.04). The pain rating scale score was lower in the HFNC group than in the WhisperFlow CPAP group at 24 h (2.8 ± 2.0 vs. 3.7 ± 1.9, P = 0.02) and 48 h (2.8 ± 1.8 vs. 3.8 ± 1.9, P = 0.002).
We are unable to demonstrate a reduction in postextubation respiratory failure in at risk patients with the use of HFNC compared with the WhisperFlow CPAP system probably because small sample size, but HFNC was better tolerated.
比较高流量鼻导管（HFNC）与 WhisperFlow CPAP 系统在有拔管后失败风险的患者中的疗效（再插管率）。
对至少有一个拔管后失败高风险标准的患者进行 RCT。所有患者均随机分配至 CPAP 或 HFNC 组，持续 48 小时。
在 140 例患者中，69 例被分配至 CPAP 组，71 例被分配至 HFNC 组。HFNC 与 WhisperFlow CPAP 的再插管率相似[5 例（7.0%）比 6 例（8.7%）；P=0.76]。HFNC 与 WhisperFlow CPAP 组的拔管后呼吸衰竭发生率无显著差异[10 例（14.1%）比 7 例（10.1%）；P=0.48]。HFNC 组的呼吸频率低于 CPAP 组（P=0.04）。HFNC 组在 24 小时（2.8±2.0 比 3.7±1.9，P=0.02）和 48 小时（2.8±1.8 比 3.8±1.9，P=0.002）时的疼痛评分量表得分均低于 WhisperFlow CPAP 组。
我们未能证明与 WhisperFlow CPAP 系统相比，HFNC 可降低有拔管后失败风险的患者的呼吸衰竭发生率，这可能是因为样本量小，但 HFNC 更能耐受。
