Tuberc Respir Dis > Volume 85(4); 2022 > Article
Sim, Choi, Oh, Min, Hur, Lee, Shim, and Lee: Cardiac Dysfunction Is Not Associated with Increased Reintubation Rate in Patients Treated with Post-extubation High-Flow Nasal Cannula

Abstract

Background

Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period.

Methods

We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation.

Results

Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292).

Conclusion

Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

Introduction

High-flow nasal cannula (HFNC) is increasingly used in critically ill patients, because it has a number of advantages over conventional oxygen therapy (COT) or non-invasive ventilation (NIV) including favorable physiologic parameters, ease of use, and patient comfort [1,2]. It is mainly indicated for patients with acute hypoxemic respiratory failure [3,4], but can also be applied to various conditions including post-extubation [5-7].
HFNC has been demonstrated to be superior to COT in terms of reducing reintubation rate and post-extubation respiratory failure in patients with low risk for reintubation [6]. However, only a few patients meet the low risk criteria because intensive care unit (ICU) patients are getting older and often have multiple comorbidities [8]. Recently, two randomized trials compared the efficacy of HFNC on reintubation with NIV or NIV plus HFNC in high risk patients. HFNC was non-inferior to NIV but inferior to NIV plus HFNC as preventive measures in post-extubation period [9,10]. Based on these results, applying NIV during post-extubation period may be advisable in high risk patients. Indeed, current guidelines recommend preventative NIV after extubation in high risk patients though the strength of recommendation or the degree of evidence differs [11,12]. However, given that most of medical ICU patients belong to high risk group and NIV has several drawbacks such as poor tolerance, cost, and need for trained staff [13], it is difficult to apply NIV to every high risk patients in practice. Moreover, high risk group was defined differently in each study, and it was composed of heterogeneous patients. Therefore, it seems reasonable to refine and narrow down the high risk group.
Past studies found that cardiac dysfunction, either as a cause of respiratory failure or as an underlying disease, harbors increased risk of reintubation [14,15]. However, in those studies, COT was applied after extubation, so the situation is different from the current increasing use of post-extubation HFNC [16]. We planned this study to investigate association between cardiac dysfunction and reintubation rate within 72 hours in situation where HFNC was widely used during post-extubation period.

Materials and Methods

1. Study design and population

We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical ICU at Korea University Guro Hospital between January 2017 and December 2019. This study was approved by the Institutional Review Board (2020GR0518). The need for informed consent was waived because of the observational nature of the study. Adult patients who were admitted to the medical ICU and mechanically ventilated for ≥48 hours, passed a spontaneous breathing trial (SBT), and were supported by HFNC immediately after extubation were included in the study. Patients were excluded according to the following criteria: application of COT or NIV immediately after extubation; no planned extubation; and no echocardiography data during the ICU stay.

2. Weaning and post-extubation practice

Patients ventilated for >24 hours underwent a spontaneous awakening trial, and if successful, they were evaluated for the possibility of weaning according to the institutional protocol. A patient underwent SBT with 8-10 cm H2O pressure support and 6 cm H2O positive end-expiratory pressure when the condition leading to intubation had been improved, and hemodynamic and respiratory stabilities were achieved. If a patient passed SBT, extubation ensued. After planned extubation, HFNC (Airvo 2, Fisher and Paykel Healthcare, Laval, QC, Canada) was initiated at a flow rate of 50 L/min with fraction of inspired oxygen (FiO2) of 0.5. Detailed protocol of weaning and post-extubation practice was reported in elsewhere [17].

3. Data collection

Data were collected retrospectively for all patients commencing HFNC after extubation during the study period. To reduce bias, well-trained research nurses collected data from the electronic medical records (EMRs) using standardized data collection protocols, and patients with >20% missing data for each variable were excluded from the analysis. Baseline characteristics including demographic features, and clinical and laboratory findings at the time of admission and extubation were collected. Physiologic parameters and HFNC settings (flow rate and FiO2) were serially recorded after extubation. For patients who required reintubation, the time from extubation to reintubation was documented, and the reason for reintubation was described. The primary outcome was reintubation rate within 72 hours following extubation. Secondary outcomes included the time to reintubation, the reason for reintubation, ICU length of stay (LOS), ICU mortality, and hospital mortality.

4. Cardiac dysfunction

In our practice, formal echocardiography has been routinely performed within 3 working days after ICU admission. An echocardiographer carried out the examination, and cardiologists confirmed the result; neither were involved in this study. The ejection fraction (EF) was measured by modified Simpson method. Cardiac dysfunction was defined as EF <45% [18]. Eligible patients were divided into normal group (EF ≥45%) and cardiac dysfunction group (EF <45%).

5. Statistical analysis

Continuous variables are reported as the median with interquartile range, and categorical variables as the number and percentage. Baseline characteristics and clinical outcomes were compared between the two groups using Fisher’s exact test and the Mann-Whitney U test, as appropriate. We compared changes in vital signs and HFNC settings over the first 12 hours after extubation using a generalized linear model. The cumulative rate of reintubation was assessed by Kaplan-Meier curve and compared using the log-rank test. To investigate factors associated with reintubation within 72 hours following extubation, Cox proportional hazard model was used. Variables with p<0.05 in univariate analysis and cardiac dysfunction were incorporated in multivariate analysis. The results were reported as hazard ratio (HR) of each variable with 95% confidence intervals (CI). Data were analyzed using SPSS version 20.0 (IBM Corp., Armonk, NY, USA) and GraphPad Prism version 9.0 (GraphPad Software, San Diego, CA, USA). All tests were two-sided, and p<0.05 was taken to indicate statistical significance.

Results

During the study period, 880 patients were treated with mechanical ventilation in the medical ICU. Of these patients, 222 were excluded because they failed to proceed to planned extubation; 52 patients were excluded because of insufficient EMRs; 288 were excluded because they were treated with COT after extubation; and 42 were excluded because they were treated with NIV after extubation. Therefore, 276 patients were included in the study. As EF data were not available for six patients, 270 were included in the final analysis (Figure 1). The median follow-up period was 22 days.

1. Baseline characteristics

Overall, there were no differences in baseline characteristics between the two groups (Table 1). On the day of extubation, patients in the cardiac dysfunction group had higher rates of treatment with vasoactive agents, particularly dobutamine, compared to the normal function group (45.7% vs. 16.2%, p<0.001). Renal replacement therapy was applied more frequently in the cardiac dysfunction group than the normal function group, although the difference was not significant (20% vs. 9.4%, p=0.076). The degree of organ dysfunction, gas exchange, and vital signs were similar in both groups. Oxygenation indices, including partial pressure of oxygen (PaO2) and the PaO2/FiO2 ratio, were higher in the cardiac dysfunction group (121 mm Hg vs. 103 mm Hg, p=0.009; 373 vs. 286, p=0.001). The abnormal cardiac findings of each group are shown in Supplementary Table S1.

2. Group comparison of changes in physiologic parameters and HFNC settings

There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure (Figure 2). There was also no group difference in changes in flow rate and FiO2, which tended to decrease over time in both groups (Figure 3).

3. Clinical outcomes

The clinical outcomes in the cardiac dysfunction and normal function groups are presented in Table 2. The rate of reintubation was not different between the two groups (20% vs. 17%, p=0.637), but the main reason for reintubation was different. In the normal function group, worsening respiratory condition (10.6%) and inability to clear secretion (4.2%) were common causes of reintubation. In the cardiac dysfunction group, worsening respiratory condition (8.5%) and hemodynamic instability (8.5%) were common causes (p=0.014). The median ICU LOS was shorter in the cardiac dysfunction group (7 days vs. 10 days, p=0.042). ICU and hospital mortalities were higher in normal and cardiac dysfunction group, respectively without statistical significance. The median time to reintubation was not different between the two groups (16 hours vs. 16.5 hours, p=0.510), and most cases of reintubation occurred within the first 24 hours (Supplementary Figure S1). The cumulative rate of reintubation was depicted by the Kaplan-Meier curve (Figure 4). The results of Cox regression analysis were given in Table 3. The presence of cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (HR, 1.56; 95% CI, 0.683-3.558; p=0.292).

Discussion

In this study, we categorized patients into normal and cardiac dysfunction groups based on EF, and compared reintubation rate under condition of HFNC following planned extubation. Interestingly, it was not higher in patients with cardiac dysfunction, which is established risk factor of reintubation. In addition, clinical outcomes and physiologic responses after extubation were similar between two groups.
For patients with cardiac dysfunction, positive pressure ventilation provides advantages of lowering left ventricular preload [19]. Because extubation eliminates these benefits, it could lead to pulmonary edema and respiratory failure. However, HFNC can supply inspiratory pressure based on flow rate. Roca et al. [20] reported that HFNC reduced inspiratory collapse of inferior vena cava (IVC) in patients with heart failure, indicating a decrease in preload. In addition, when the flow rate was increased from 20 L/min to 40 L/min, the inspiratory collapse of IVC was significantly reduced from 28% to 21% [20]. In our study, the median flow rate was about 45 L/min, which might be effective to prevent the increase in preload following extubation. Of note, all reintubation events occurred within first 24 hours in the cardiac dysfunction group. These findings might reflect rapid response to elimination of positive pressure in those patients who were greatly affected by positive pressure. However, there was no statistical significance, and few studies examined the relation of cause of extubation failure, its onset time, and patient characteristics.
In previous studies, patients at high risk of reintubation were heterogeneous, so the effectiveness of NIV may vary depending on patients’ characteristics. Ferrer et al. [21] reported that NIV was superior to COT in terms of respiratory failure and mortality, but there was no difference in reintubation rate, and a mortality benefit was found in patients with hypercapnia. In another study demonstrating the efficacy of NIV in high risk patients, about one third of patients had persistent hypercapnia [22]. A recent trial showed that NIV tended to work better in hypercapnic patients [10]. In contrast, Chang et al. showed that the reintubation rate was not different between heart failure patients treated with NIV or HFNC. Notably, the number of chronic obstructive pulmonary disease patients was small in that study [23]. In our study, carbon dioxide concentration of the two groups was in the normal range. Based on these findings, post-extubation NIV is helpful for hypercapnic patients. However, it does not seem essential for patients with cardiac dysfunction, who are normocapnic and supported with HFNC.
Although this study suggested the utility of post-extubation HFNC in patients with cardiac dysfunction, several limitations should be acknowledged. First, cardiac dysfunction was the accompanying characteristics, neither the primary diagnosis nor the cause of respiratory failure. In several studies, patients were regarded as high risk group when cardiac failure was the primary indication for mechanical ventilation [9,14,21]. Therefore, caution should be taken when applying our findings to such patients. Second, EF was not measured at the time of SBT or extubation. It would be better to understand the association between cardiac function and reintubation risk if EF was measured at that moment. However, unlike previous work that did not present EF measurement time [10,15,22], we provided EF near the time of SBT or extubation, reflecting cardiac function more precisely. Third, respiratory mechanics such as rapid shallow breathing index or maximal inspiratory pressure were not compared or included in the analysis though they were well-known weaning predictors. However, SBT was performed according to the institutional protocol in which tidal volume and respiratory are included [17], we believe that respiratory rate, tidal volume, and eventually rapid shallow breathing index would be in adequate range in both groups. In addition, this study was conducted retrospectively at a single institution in a small number of medical ICU patients. Therefore, one should be cautious to generalize our findings, and sample size would be not enough to detect statistical significance. As is well known, retrospective study is not free from bias. In patients with cardiac dysfunction, only those with a less severe condition may have been included in the study; severe cases may have been treated with NIV or tracheostomized. In fact, ICU LOS was shorter, and ICU mortality was lower in cardiac dysfunction group, although the differences were not statistically significant. Oxygenation indices were also better in cardiac dysfunction group. On the other hand, there were no differences in age, comorbidities, severity at admission, or degree of organ dysfunction on the day of extubation between the two groups. Renal failure was more prevalent in cardiac dysfunction group. In addition, the number of patients with NIV support following extubation was small during the study period. Patients in the cardiac dysfunction group were treated more frequently with dobutamine on the day of extubation. Use of dobutamine may have reduced the difference in EF between the two groups and helped to overcome hemodynamic burden following extubation. But, in Cox regression analysis, dobutamine use was not associated with increased reintubation rate (Table 3). Finally, we did not directly compare HFNC and NIV. However, as the reintubation rate did not differ between the normal function and cardiac dysfunction groups, we judged that cardiac dysfunction is not significant risk factor when HFNC is applied immediately after extubation.
In conclusion, cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation. Our findings suggest the possibility that risk factors of reintubation may differ depending on which modality are applied. Further research is required to identify and reassess risk factors of reintubation.

Notes

Authors’ Contributions

Conceptualization: Sim JK, Lee YS. Methodology: Lee YS. Validation: Min KH, Hur GY, Lee SY, Shim JJ. Formal analysis: Sim JK. Data curation: Sim JK, Choi J, Oh JY. Writing - original draft preparation: Sim JK. Writing - review and editing: Sim JK, Lee YS. Approval of final manuscript: all authors.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Funding

No funding to declare.

Supplementary Material

Supplementary material can be found in the journal homepage (http://www.e-trd.org).
Supplementary Table S1.
Abnormal cardiac findings.
trd-2022-0040-suppl1.pdf
Supplementary Figure S1.
Reintubation rate at intervals of 24 hours within the 72 hours after extubation.
trd-2022-0040-suppl2.pdf

Figure 1.
Flow chart of enrolled patients. ICU: intensive care unit; EMR: electronic medical record; SBT: spontaneous breathing trial; COT: conventional oxygen therapy; NIV: non-invasive ventilation; HFNC: high-flow nasal cannula; EF: ejection fraction.
trd-2022-0040f1.jpg
Figure 2.
Group comparison of changes in physiologic parameters within 12 hours after extubation. (A) Systolic blood pressure change within 12 hours after extubation. (B) Diastolic blood pressure change within 12 hours after extubation. (C) Heart rate change within 12 hours after extubation. (D) Respiratory rate change within 12 hours after extubation.
trd-2022-0040f2.jpg
Figure 3.
Group comparison of changes in high-flow nasal cannula settings within 12 hours after extubation. (A) FiO2 change within 12 hours after extubation. (B) Flow rate within 12 hours after extubation. FiO2: fraction of inspired oxygen.
trd-2022-0040f3.jpg
Figure 4.
Kaplan-Meier plots showing the cumulative rate of reintubation within 72 hours after extubation according to the presence of cardiac dysfunction.
trd-2022-0040f4.jpg
Table 1.
Baseline characteristics
Variable Normal (n=235) Cardiac dysfunction (n=35) p-value
Male 149 (63.4) 22 (62.9) >0.99
BMI, kg/m2 21 (18-24) 22 (20-26) 0.110
APACHE II 30 (27-33) 31 (28-34) 0.119
Charlson Comorbidity Index 6 (4-8) 6 (4-8) 0.185
Admission diagnosis
 Cardiac disease 11 (4.7) 1 (2.9) >0.99
 Pulmonary disease 146 (62.1) 26 (74.3) 0.190
 Gastrointestinal disease 4 (1.7) 0 (0) >0.99
 Renal disease 2 (0.9) 0 (0) >0.99
 Neurologic disease 20 (8.5) 2 (5.7) 0.749
 Malignancy 2 (0.9) 0 (0) >0.99
 Others 50 (21.3) 6 (17.1) 0.661
Cause of respiratory failure*
 Pulmonary 209 (89.3) 32 (91.4) 0.833
 Extra-pulmonary 25 (10.7) 3 (8.6) >0.99
Blood gas analysis
 pH 7.49 (7.45-7.52) 7.48 (7.45-7.52) 0.682
 PaCO2, mm Hg 35 (31-40) 35 (31-37) 0.308
 PaO2, mm Hg 103 (81-126) 121 (92-135) 0.009
 HCO3, mmol/L 27 (23-30) 26 (23-28) 0.132
 SaO2, % 98 (97-99) 99 (98-99) 0.076
PaO2/FiO2 ratio 286 (223-390) 373 (290-437) 0.001
Vital signs
 SBP, mm Hg 129 (113-144) 124 (112-142) 0.539
 DBP, mm Hg 71 (61-81) 66 (58-80) 0.141
 HR, /min 93 (80-106) 92 (84-107) 0.987
 RR, /min 21 (17-26) 20 (17-25) 0.361
Vasoactive agent use 84 (35.7) 23 (65.7) 0.001
 Norepinephrine 55 (23.4) 12 (34.3) 0.207
 Dopamine 10 (4.3) 3 (8.6) 0.229
 Dobutamine 38 (16.2) 16 (45.7) <0.001
Renal replacement therapy 22 (9.4) 7 (20.0) 0.076
SOFA score 7 (5-9) 7 (5-10) 0.394

Values are presented as median (interquartile range) or number (%).

Patients were divided into normal function group (ejection fraction ≥45%) and cardiac dysfunction group (ejection fraction <45%).

* One patient was excluded in normal group due to missing data.

Data were collected on the day of extubation.

BMI: body mass index; APACHE II: Acute Physiology and Chronic Health Evaluation II; PaCO2: partial pressure of carbon dioxide; PaO2: partial pressure of oxygen; SaO2: arterial oxygen saturation; FiO2: fraction of inspired oxygen; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; RR: respiratory rate; SOFA: Sequential Organ Failure Assessment.

Table 2.
Clinical outcomes
Outcome Normal (n=235) Cardiac dysfunction (n=35) p-value
Reintubation 40 (17.0) 7 (20.0) 0.637
Time to reintubation, hr 16.5 (5-26) 16 (5-19) 0.510
Reason for reintubation 0.014
 Decreased level of consciousness 1 (0.4) 1 (2.8)
 Cardiac arrest 2 (0.8) 0 (0)
 Hemodynamic instability 2 (0.8) 3 (8.5)
 Inability to clear secretion 10 (4.2) 0 (0)
 Worsening respiratory condition 25 (10.6) 3 (8.5)
ICU length of stay, day 10 (6-15) 7 (5-10) 0.042
ICU mortality 26 (11.1) 1 (2.9) 0.222
Hospital mortality 64 (27.2) 12 (34.3) 0.422

Values are presented as number (%) or median (interquartile range).

Patients were divided into normal function group (ejection fraction ≥45%) and cardiac dysfunction group (ejection fraction <45%).

ICU: intensive care unit.

Table 3.
Factors affecting reintubation within 72 hours after extubation
Variable Univariate analysis
Multivariate analysis
HR (95% CI) p-value HR (95% CI) p-value
Cardiac dysfunction (EF <45%) 1.32 (0.59-2.96) 0.494 1.56 (0.68-3.56) 0.292
Age 1.01 (0.99-1.04) 0.378 - -
Male 2.22 (1.10-4.47) 0.025 2.43 (1.20-4.91) 0.014
APACHE II 0.99 (0.95-1.04) 0.936 - -
Charlson Comorbidity Index 0.99 (0.90-1.09) 0.867 - -
Vasoactive agent use
 Norepinephrine 1.86 (1.04-3.36) 0.038 2.18 (1.20-3.95) 0.011
 Dopamine 0.52 (0.07-3.38) 0.519 - -
 Dobutamine 1.45 (0.77-2.75) 0.253 - -
Renal replacement therapy 1.17 (0.50-2.76) 0.720 - -
SOFA at the time of extubation 1.07 (0.96-1.19) 0.199 - -
PaO2/FiO2 ratio before extubation 0.99 (0.99-1.00) 0.040 0.99 (0.99-1.00) 0.017
PaCO2 before extubation 1.01 (0.97-1.06) 0.499 - -

Multivariate Cox regression analysis was performed to investigate factors affecting the reintubation within 72 hours after extubation incorporating cardiac dysfunction and other variables with p-value less than 0.05 in univariate analysis.

HR: hazard ratio; CI: confidence interval; EF: ejection fraction; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential Organ Failure Assessment; PaO2/FiO2 ratio: partial pressure of oxygen and fraction of inspired oxygen ratio; PaCO2: partial pressure of carbon dioxide.

References

1. Ricard JD, Roca O, Lemiale V, Corley A, Braunlich J, Jones P, et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med 2020;46:2238-47.
crossref pmid pmc pdf
2. Roca O, Hernandez G, Diaz-Lobato S, Carratala JM, Gutierrez RM, Masclans JR, et al. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care 2016;20:109.
crossref pmid pmc
3. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-96.
crossref pmid
4. Messika J, Ben Ahmed K, Gaudry S, Miguel-Montanes R, Rafat C, Sztrymf B, et al. Use of high-flow nasal cannula oxygen therapy in subjects with ARDS: a 1-year observational study. Respir Care 2015;60:162-9.
crossref pmid
5. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med 2014;190:282-8.
crossref pmid
6. Hernandez G, Vaquero C, Gonzalez P, Subira C, Frutos-Vivar F, Rialp G, et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA 2016;315:1354-61.
crossref pmid
7. Zhu Y, Yin H, Zhang R, Ye X, Wei J. High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis. Crit Care 2019;23:180.
crossref pmid pmc pdf
8. Heo J, Hong Y, Han SS, Kim WJ, Kwon JW, Moon KW, et al. Changes in the characteristics and long-term mortality rates of intensive care unit patients from 2003 to 2010: a nationwide population-based cohort study performed in the Republic of Korea. Acute Crit Care 2018;33:135-45.
crossref pmid pmc pdf
9. Hernandez G, Vaquero C, Colinas L, Cuena R, Gonzalez P, Canabal A, et al. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA 2016;316:1565-74.
crossref pmid
10. Thille AW, Muller G, Gacouin A, Coudroy R, Decavele M, Sonneville R, et al. Effect of postextubation high-flow nasal oxygen with noninvasive ventilation vs high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: a randomized clinical trial. JAMA 2019;322:1465-75.
crossref pmid pmc
11. Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, et al. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society clinical practice guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest 2017;151:166-80.
crossref pmid
12. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426.
crossref pmid
13. Lopez-Campos JL, Garcia Polo C, Leon Jimenez A, Arnedillo A, Gonzalez-Moya E, Fenandez Berni JJ. Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure. Monaldi Arch Chest Dis 2006;65:145-51.
crossref pmid pdf
14. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.
crossref pmid
15. Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med 2011;39:2612-8.
crossref pmid
16. Sim JK, Lee SM, Kang HK, Kim KC, Kim YS, Kim YS, et al. Change in management and outcome of mechanical ventilation in Korea: a prospective observational study. Korean J Intern Med 2022;37:618-30.
crossref pmid pmc pdf
17. Lee YS, Chang SW, Sim JK, Kim S, Kim JH. An integrated model including the ROX index to predict the success of high-flow nasal cannula use after planned extubation: a retrospective observational cohort study. J Clin Med 2021;10:3513.
crossref pmid pmc
18. Thille AW, Boissier F, Ben Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C. Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study. Crit Care Med 2015;43:613-20.
pmid
19. Alviar CL, Miller PE, McAreavey D, Katz JN, Lee B, Moriyama B, et al. Positive pressure ventilation in the cardiac intensive care unit. J Am Coll Cardiol 2018;72:1532-53.
crossref pmid
20. Roca O, Perez-Teran P, Masclans JR, Perez L, Galve E, Evangelista A, et al. Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure. J Crit Care 2013;28:741-6.
pmid
21. Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 2006;173:164-70.
crossref pmid
22. Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33:2465-70.
crossref pmid
23. Chang CJ, Chiang LL, Chen KY, Feng PH, Su CL, Hsu HS. High-flow nasal cannula versus noninvasive positive pressure ventilation in patients with heart failure after extubation: an observational cohort study. Can Respir J 2020;2020:6736475.
crossref pmid pmc pdf


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