High-Flow Versus VenturiMask Oxygen Therapy to Prevent Reintubation in Hypoxemic Patients after Extubation A Multicenter Randomized Clinical Trial
High-Flow Versus VenturiMask Oxygen Therapy to Prevent Reintubation in Hypoxemic Patients after Extubation A Multicenter Randomized Clinical Trial
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DOI：
10.1164/rccm.202201-0065oc
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发表时间：
2022-12-15
影响因子：
24.7
通讯作者：
Antonelli, Massimo
中科院分区：
文献类型：
--
作者：
Maggiore, Salvatore Maurizio;Jaber, Samir;Antonelli, Massimo
基本原理：当拔管后与VenturiMask相比时，高流量鼻氧提供了生理优势。Objectives：To establish whether high-flow oxygen prevents intracranial reintubation in hypoxemic patients after extubation，compared with VenturiMask.Methods：在这项多中心随机试验中，拔管后PaO 2：FIO 2比值< 300 mm Hg的494例患者被随机分配接受高流量或VenturiMask氧气，并有可能在重新插管前应用抢救性无创通气。VenturiMask组中的高流量使用是不允许的。测量和主要结果：主要结果是根据预定义的标准，这是由一个独立的裁定委员会验证后72小时内重新插管的比率。主要次要结局包括28天时的重新插管率和根据预定标准进行抢救性无创通气的需要。插管标准验证后（n = 492例患者），高流量组32例患者（13%）和VenturiMask组27例患者（11%）在72小时需要重新插管（未校正比值比，1.26 [95%置信区间（CI），0.70-2.26]; P = 0.49）。第28天时，高流量组和VenturiMask组的再插管率分别为21%和23%（校正风险比，0.89 [95%CI，0.60-1.31]; P = 0.55）。高流量组的急救无创通气需求显著低于VenturiMask组：72小时时，8%对17%（校正的风险比，0.39 [95% CI，0.22-0.71]; P = 0.002）和28天时，12% vs 21%（调整后的风险比，0.52 [95%CI，0.32-0.83]; P = 0.007）结论：拔管后使用VenturiMask或高流量氧气治疗的患者之间的重新插管率没有显著差异。高流量氧气导致抢救无创通气使用频率降低。
Rationale: When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages.Objectives: To establish whether high-flow oxygen prevents endotracheal reintubation in hypoxemic patients after extubation, compared with VenturiMask.Methods: In this multicenter randomized trial, 494 patients exhibiting PaO2:FIO2 ratio< 300 mm Hg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before reintubation. High-flow use in the VenturiMask group was not permitted.Measurements and Main Results: The primary outcome was the rate of reintubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included reintubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n = 492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required reintubation at 72 hours (unadjusted odds ratio, 1.26 [95% confidence interval (CI), 0.70-2.26]; P = 0.49). At 28 days, the rate of reintubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio, 0.89 [95% CI, 0.60-1.31]; P = 0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% versus 17% (adjusted hazard ratio, 0.39 [95% CI, 0.22-0.71]; P = 0.002) and at 28 days, 12% versus 21% (adjusted hazard ratio, 0.52 [95% CI, 0.32-0.83]; P = 0.007).Conclusions: Reintubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded less frequent use of rescue noninvasive ventilation.