Please use this identifier to cite or link to this item: https://doi.org/10.47102/annals-acadmedsg.2020564
Title: Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study
Authors: Kansal, Amit
Dhanvijay, Shekhar
Li, Andrew
Phua, J. 
Cove, Matthew Edward
Ong, Wei Jun Dan
Puah, Ser Hon
Ng, Vicky
TAN QIAO LI 
Manalansan, Julipie Sumampong
Zamora, Michael Sharey Nocon
Vidanes, Michael Camba
Sahagun, Juliet Tolentino
Taculod, Juvel
TAN YONG HUI ADDY 
TAY CHEE KIANG MELVIN 
CHIA YEW WOON 
SEWA DUU WEN(CAI DUWEN) 
Chew, Meiying
Lew, Sennen JW
Goh, Shirley
Tan, Jonathan Jit-Ern
Ramanathan, Kollengode
Mukhopadhyay, A. 
See, K.C. 
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Adult
airway extubation
high-flow nasal cannula
mechanical ventilation
respiratory failure
POSTEXTUBATION RESPIRATORY-FAILURE
NONINVASIVE VENTILATION
RISK
REINTUBATION
MORTALITY
DELIVERY
Issue Date: 1-Jun-2021
Publisher: ACAD MEDICINE SINGAPORE
Citation: Kansal, Amit, Dhanvijay, Shekhar, Li, Andrew, Phua, J., Cove, Matthew Edward, Ong, Wei Jun Dan, Puah, Ser Hon, Ng, Vicky, TAN QIAO LI, Manalansan, Julipie Sumampong, Zamora, Michael Sharey Nocon, Vidanes, Michael Camba, Sahagun, Juliet Tolentino, Taculod, Juvel, TAN YONG HUI ADDY, TAY CHEE KIANG MELVIN, CHIA YEW WOON, SEWA DUU WEN(CAI DUWEN), Chew, Meiying, Lew, Sennen JW, Goh, Shirley, Tan, Jonathan Jit-Ern, Ramanathan, Kollengode, Mukhopadhyay, A., See, K.C. (2021-06-01). Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study. ANNALS ACADEMY OF MEDICINE SINGAPORE 50 (6) : 467-473. ScholarBank@NUS Repository. https://doi.org/10.47102/annals-acadmedsg.2020564
Abstract: INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, P<0.001), ICU mortality (14.6% versus 2.0%, P<0.001) and hospital mortality (29.3% versus 12.3%, P=0.006). CONCLUSION: Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Source Title: ANNALS ACADEMY OF MEDICINE SINGAPORE
URI: https://scholarbank.nus.edu.sg/handle/10635/208663
ISSN: 0304-4602
DOI: 10.47102/annals-acadmedsg.2020564
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