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October 2, 2019

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

Author Affiliations
  • 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  • 3Division of Respirology, Department of Medicine, University Health Network, Sinai Health System, Toronto, Ontario, Canada
  • 4Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
  • 5Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 6Toronto General Hospital Research Institute, Toronto, Ontario, Canada
JAMA. 2019;322(15):1455-1457. doi:10.1001/jama.2019.14609

Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation—ie, when the reasons for intubation are substantially improved and a number of clinical stability criteria are met. Second, patients who meet these “readiness to wean” criteria are then assessed for their ability to breathe through the endotracheal tube with little or no assistance from the ventilator during a so-called spontaneous breathing trial (SBT). Third, for patients who pass their SBT, clinicians must judge whether those patients will be able to sustain ventilation once the endotracheal tube has been removed, maintaining airway patency and clearance of secretions.