Maggiore Salvatore Maurizio, Jaber Samir, Grieco Domenico Luca, Mancebo Jordi, Zakynthinos Spyros, Demoule Alexandre, Ricard Jean-Damien, Navalesi Paolo, Vaschetto Rosanna, Hraiech Sami, Klouche Kada, Frat Jean-Pierre, Lemiale Virginie, Fanelli Vito, Chanques Gerald, Natalini Daniele, Ischaki Eleni, Reuter Danielle, Morán Indalecio, La Combe Béatrice, Longhini Federico, De Gaetano Andrea, Ranieri V Marco, Brochard Laurent J, Antonelli Massimo
University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy.
Am J Respir Crit Care Med. 2022 Dec 15;206(12):1452-1462. doi: 10.1164/rccm.202201-0065OC.
When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. To establish whether high-flow oxygen prevents endotracheal reintubation in hypoxemic patients after extubation, compared with VenturiMask. In this multicenter randomized trial, 494 patients exhibiting Pa:Fi ratio ⩽ 300 mm Hg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before reintubation. High-flow use in the VenturiMask group was not permitted. The primary outcome was the rate of reintubation within 72 hours according to predefined criteria, which were validated by an independent adjudication committee. Main secondary outcomes included reintubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation ( = 492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required reintubation at 72 hours (unadjusted odds ratio, 1.26 [95% confidence interval (CI), 0.70-2.26]; = 0.49). At 28 days, the rate of reintubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio, 0.89 [95% CI, 0.60-1.31]; = 0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% versus 17% (adjusted hazard ratio, 0.39 [95% CI, 0.22-0.71]; = 0.002) and at 28 days, 12% versus 21% (adjusted hazard ratio, 0.52 [95% CI, 0.32-0.83]; = 0.007). Reintubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded less frequent use of rescue noninvasive ventilation. Clinical trial registered with www.clinicaltrials.gov (NCT02107183).
与拔管后使用文丘里面罩相比，高流量鼻导管吸氧具有生理优势。为确定与文丘里面罩相比，高流量吸氧能否预防低氧血症患者拔管后再次气管插管。在这项多中心随机试验中，494例拔管后动脉血氧分压与吸入氧浓度比值（Pa:Fi ratio）≤300 mmHg的患者被随机分配接受高流量吸氧或文丘里面罩吸氧，并有可能在再次插管前应用挽救性无创通气。文丘里面罩组不允许使用高流量吸氧。主要结局是根据预定义标准在72小时内的再次插管率，该标准由独立判定委员会进行验证。主要次要结局包括28天的再次插管率以及根据预定义标准进行挽救性无创通气的需求。在插管标准验证后（n = 492例患者），高流量组32例患者（13%）和文丘里面罩组27例患者（11%）在72小时内需再次插管（未调整优势比，1.26 [95%置信区间（CI），0.70 - 2.26]；P = 0.49）。在28天时，高流量组再次插管率为21%，文丘里面罩组为23%（调整后风险比，0.8
