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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 |
Appears in Collections: | Staff Publications Elements |
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