No difference in reintubation rate with mask vs. high-flow nasal oxygen after extubation

The rate of reintubation at 72 hours and 28 days was not different among patients with hypoxemia after extubation who received VenturiMask oxygen compared with high-flow nasal oxygen.

The VenturiMask provides gas mixtures to patients at higher flow rates compared with low-flow devices used for oxygen therapy in previous studies, Salvatore Maurizio Maggiore, MD, PhD, from the department of innovative technologies in medicine and dentistry at Gabriele d’Annunzio University of Chieti-Pescara and the department of anesthesiology, critical care medicine and emergency at SS Annunziata Hospital in Chieti, Italy, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine.

“We previously demonstrated that, compared to VenturiMask after extubation in hypoxemic patients recovering from respiratory failure, high-flow nasal oxygen improves oxygenation and reduces [partial pressure of carbon dioxide] respiratory rate and discomfort,” Maggiore and colleagues wrote. “Whether these physiological benefits translate into improved extubation weaning outcome remains to be established.”

The investigator-initiated, open-label, multicenter randomized trial included 494 patients with a partial pressure of oxygen/fraction of inspired oxygen ratio of 300 mm Hg or less following extubation in 13 ICUs in Italy, France, Spain and Greece from June 2014 to October 2016. All patients were randomly assigned to receive VenturiMask oxygen (n = 251; mean age, 63 years; 66% men) or high-flow nasal oxygen (n = 243; mean age, 62 years; 70% men). Before reintubation, patients had the option to apply rescue noninvasive ventilation, but high-flow nasal oxygen use among patients in the VenturiMask group was not permitted, the researchers wrote.

The primary outcome was the rate of reintubation within 72 hours and secondary outcomes included reintubation rates at 28 days and the need for rescue noninvasive ventilation.

At 72 hours, 13% of patients in the high-flow group and 11% of patients in the VenturiMask group required reintubation (OR = 1.26; 95% CI, 0.7-2.26; P = .49), according to the results.

At 28 days, reintubation rates were 21% and 23% in the high-flow and VenturiMask groups, respectively (aHR = 0.89; 95% CI, 0.6-1.31; P = .055).

Patients in the high-flow group had significantly lower need for rescue noninvasive ventilation compared with patients in the VenturiMask group at 72 hours (8% vs. 17%; aHR = 0.39; 95% CI, 0.22-0.71; P = .002) and at 28 days (12% vs. 21%; aHR = 0.52; 95% CI, 0.32-0.83; P = .007), the researchers wrote.