Ruan Sheng-Yuan, Kuo Yao-Wen, Huang Chun-Ta, Chien Ying-Chun, Huang Chun-Kai, Kuo Lu-Cheng, Kuo Jerry Shu-Hung, Chung Kuei-Pin, Ku Shih-Chi, Chien Jung-Yien
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine National Taiwan University, Taipei, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine National Taiwan University, Taipei, Taiwan; Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Chest. 2025 May;167(5):1388-1396. doi: 10.1016/j.chest.2024.12.021. Epub 2024 Dec 30.
High-flow nasal cannula (HFNC) has emerged as a promising intervention for postextubation oxygen therapy, with the potential to reduce the need for reintubation. However, it remains unclear whether using a higher flow setting provides better outcomes than the commonly used flow rate of 30 to 50 L/min.
Does setting the flow rate of HFNC at 60 L/min vs 40 L/min for postextubation care result in different extubation outcomes?
This randomized controlled trial assigned intubated patients to receive HFNC at either a 60 L/min or 40 L/min flow rate following extubation. The assigned flow rate was maintained for 24 hours. The primary outcome was a composite of reintubation or the use of noninvasive ventilation (NIV) within 48 hours' after extubation. Key secondary outcomes included ahead-of-schedule changes in HFNC settings and mortality.
A total of 180 patients were randomized; 169 were included in the analysis (86 in the 40 L/min group and 83 in the 60 L/min group). The primary outcome events occurred in 19 patients (22.1%) in the 40 L/min group and in 14 patients (16.9%) in the 60 L/min group (risk difference, 5.2%; 95% CI, -6.7% to 17.1%; P = .39). For secondary outcomes, the 40 L/min group was associated with a higher risk of escalation in respiratory support, defined as using NIV or up-titration of HFNC settings (24 [27.9%] vs 8 [9.6%]; P = .002).
In unselected extubated patients, setting the HFNC flow rate at 60 L/min did not reduce the risk of reintubation or NIV use compared with a flow rate of 40 L/min. Using a flow rate of 40 L/min with as-needed up-titration may be a reasonable alternative to setting the flow at 60 L/min for postextubation care. However, this trial may not have been sufficiently powered to exclude a small between-group difference.
ClinicalTrials.gov; No.: NCT04934163; URL: www.
gov.
高流量鼻导管（HFNC）已成为拔管后氧疗的一种有前景的干预措施，有可能减少再次插管的需求。然而，与常用的30至50升/分钟的流速相比，使用更高的流速设置是否能带来更好的结果仍不清楚。
在拔管后护理中，将HFNC流速设置为60升/分钟与40升/分钟相比，是否会导致不同的拔管结果？
这项随机对照试验将插管患者分配为在拔管后接受流速为60升/分钟或40升/分钟的HFNC治疗。分配的流速维持24小时。主要结局是拔管后48小时内再次插管或使用无创通气（NIV）的复合情况。关键次要结局包括HFNC设置的提前更改和死亡率。
共有180例患者被随机分组；169例纳入分析（40升/分钟组86例，60升/分钟组83例）。40升/分钟组有19例患者（22.1%）发生主要结局事件，60升/分钟组有14例患者（16.9%）发生主要结局事件（风险差异为5.2%；95%CI为-6.7%至17.1%；P = 0.39）。对于次要结局，40升/分钟组呼吸支持升级的风险更高，呼吸支持升级定义为使用NIV或上调HFNC设置（24例[27.9%]对8例[9.6%]；P = 0.002）。
在未经过筛选的拔管患者中，与40升/分钟的流速相比，将HFNC流速设置为60升/分钟并不能降低再次插管或使用使用NIV的风险。对于拔管后护理，使用40升/分钟的流速并根据需要上调流速可能是将流速设置为60升/分钟的合理替代方案。然而，该试验可能没有足够的效力排除组间的微小差异。
ClinicalTrials.gov；编号：NCT04934163；网址：www. ClinicalTrials.gov
