Congestive Heart Failure, COPD, Respiratory Failure
Conditions
Keywords
high flow nasal cannula, extubation failure
Brief summary
The purpose of this study is to determine whether high flow nasal cannula is effective in lowering the reintubation rate after extubation for high risk patients in medical intensive care unit
Detailed description
The study hypothesis is that Optiflow may reduce the extubation failure rate for high risk patients in medical intensive care unit.In the intervention group, patients fulfilling inclusion criteria and not presenting any of the exclusion criteria will receive high-flow nasal cannula (Optiflow Airvo2, Fisher & Paykel Healthcare Ltd., New Zealand) after extubation. The oxygen concentration (FiO2) will be set to reach an oxygenation target similar to control patients (see below), while the gas flow rate will be set at 50 L/min.In the control group, patients fulfilling inclusion criteria and not presenting any of the exclusion criteria will receive standard oxygen therapy including nasal cannula or oxygen mask after extubation. The FiO2 will be set to obtain a arterial oxygen saturation (SpO2) between 92% and 98% (or between 88% and 95% in hypercapnic patients). NIPPV or intubation will be applied in both group if respiratory distress noted. High flow nasal cannula will be tried before NIPPV or intubation in the control group patients.
Interventions
DEVICEhigh flow nasal cannula
High flow nasal cannula used in postextubation patients
Sponsors
Mackay Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 95 Years
Healthy volunteers
No
Inclusion criteria
* Patients mechanically ventilated for \> 48 hours and at least one of the following: * \> 65 y/o * Cardiac failure as the primary indication of mechanical ventilation * COPD * Bronchiectasis * Old pulmonary tuberculosis with destructive lung * Chronic renal failure * Neuromuscular disease * BMI \> 30 * Inability to manage respiratory secretions * ARDS
Exclusion criteria
* Presence of tracheostomy * Recent facial trauma * Active gastro-intestinal bleeding * Planned NIPPV support after extubation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| reintubation rate | 72 hours after extubation |
Secondary
| Measure | Time frame |
|---|---|
| ICU readmission rate due to respiratory failure | at day 28 after inclusion in the study |
| ICU mortality rate | at day 28 after inclusion in the study |
| ICU length of stay | at day 28 after inclusion in the study |
| Hospital mortality | at day 28 after inclusion in the study |
| Hospital length of stay | at day 28 after inclusion in the study |
| Need for Non-Invasive Ventilation | at day 28 after inclusion in the study |
| Desaturation ( SaO2< 90%) | 72 hours after extubation |
| Severe hypoxemia (PaO2/Fraction of inspired O2 < 200) | Time Frame: 72 hours after extubation |
| hypercapnia (PaCO2 > 50) | 72 hours after extubation |
| respiratory acidosis (arterial pH < 7.30) | 72 hours after extubation |
| severe tachypnea (>40/min) | 72 hours after extubation |
| Nosocomial pneumonia rate | at day 28 after inclusion in the study |
Countries
Taiwan
Contacts
Primary ContactKuo li Kuo, MD
Outcome results
None listed