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April 5, 2016

High-Flow Nasal Oxygen or Noninvasive Ventilation for Postextubation HypoxemiaFlow vs Pressure?

Author Affiliations
  • 1Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
  • 2Tufts Medical Center, Boston, Massachusetts
JAMA. 2016;315(13):1340-1342. doi:10.1001/jama.2016.2709

Postextubation respiratory failure following major surgery or prolonged mechanical ventilation often necessitates reintubation and reinstitution of invasive mechanical ventilation and is associated with prolonged intensive care unit (ICU) and hospital stays and increased mortality, particularly attributable to nosocomial infection.1 Consequently, there is interest in the use of alternative strategies to standard oxygen therapy to help support patients either with or at risk of postextubation respiratory compromise in the hope of reducing the need for reintubation and improving patient outcomes. Two options include noninvasive ventilation (NIV), consisting of a strategy of delivering positive-pressure ventilation via an interface such as a sealed mask that avoids invasion of the upper airway, and, more recently, high-flow nasal oxygen therapy, involving delivery of up to 60-L/min flow rates of oxygenated gas via loose-fitting nasal prongs.

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