High Velocity Nasal Insufflation in High Risk Extubation Trials - A Randomised Controlled Study

Abstract

High velocity nasal insufflation (HVNI) is a relatively new respiratory support modality with proven effect in reducing the need for invasive mechanical ventilation but no evidence supporting its use in extubation. <bold>Aim:</bold> to study the potential of HVNI in extubation success compared to non-invasive ventilation (NIV).Failure of the HVNI arm within 72 hours of initiation is the primary outcome measure. <bold>Methods:</bold> This study prospectively recruited adult patients admitted to the ICU in a tertiary care university hospital by acute respiratory failure necessitating invasive mechanical ventilation. After 72 hours from intubation, those who are considered to be eligible for weaning but are at high risk of extubation failure were randomised to HVNI or NIV. <bold>Results:</bold> Fourty two patients with a mean age of 65 years were recruited and randomized after consenting. Overall, failed extubation was encountered in 10(24%) patients. Similar rates of failure were noted in both groups. Notably, HVNI was associated with a statistically significant higher level of tolerance compared to NIV, using Mann-Whitney U test (U=376, p<0.001). <bold>Conclusion:</bold> HVNI is non-inferior to NIV in high risk extubation with higher levels of comfort increasing chances of weaning success. <table-wrap><object-id>erj;66/suppl_69/PA4211/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col></colgroup><tbody><tr><td></td><td><bold>HVNI, n=23</bold></td><td><bold>NIV, n=19</bold></td></tr><tr><td><italic>Age, years</italic></td><td>65.8(9.7)</td><td>64.8(9.4)</td></tr><tr><td><italic>Gender, Males</italic></td><td>17</td><td>14</td></tr><tr><td><italic>BMI</italic></td><td>25.1(24.7, 25.8)</td><td>24.6(24.5, 27.0)</td></tr><tr><td><italic>PYH</italic></td><td>61.2(31)</td><td>50.7(30)</td></tr><tr><td><italic>CCI</italic></td><td>4.4(2.2)</td><td>3.8(1.4)</td></tr><tr><td><italic>APACHE II score</italic></td><td>8.7(3.7)</td><td>7.2(5.2)</td></tr></tbody></table></table-wrap> <fig><object-id>erj;66/suppl_69/PA4211/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>