E. J. Smith1, N. K. Dhillon1, A. Ko1, M. Y. Harada1, T. Li1, R. Liang1, G. Barmparas1, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: High flow nasal cannula (HFNC) is increasingly used to avoid intubating patients with hypoxemic respiratory failure. Benefits include providing PEEP, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy.
Methods: A retrospective review was conducted in the surgical intensive care unit (SICU) of an academic hospital during August 2015 to February 2016. HFNC use depended upon the rounding surgical intensivist. Demographics, ventilator days, oxygen therapy post-extubation, re-intubation rates, SICU length of stay (LOS), hospital LOS, and mortality were collected. Self and palliatively extubated patients were excluded. Characteristics and outcomes were compared between those who extubated to HFNC versus cool mist/nasal cannula (CM/NC).
Results: Of the 184 critically ill patients analyzed, 46 were extubated to HFNC and 138 to CM/NC. Mean age and days on ventilation prior to extubation were 57.8 years and 4.3 days, respectively. Both cohorts were similar in age, gender, and pre-existing pulmonary history. Although HFNC had lengthier intubation (7.1 vs. 3.4 days, p<0.001) and SICU stays prior to extubation (7.1 vs. 3.4 days, p<0.001), rate of reintubation trended lower compared to CM/NC (6.5% vs. 13.8%, p=0.19). Multivariate analysis demonstrated HFNC was associated with lower reintubation rates (AOR 0.049, p=0.032). HFNC had a similar mortality rate compared to CM/NC.
Conclusion: Ventilated patients at risk for respiratory failure have reduced reintubation rates when extubated to HFNC. Patient with prolonged intubation, the elderly or high-risk comorbidities may benefit from extubation to HFNC.