High-flow nasal cannula versus high-velocity nasal insufflation for weaning from mechanical ventilation in respiratory intensive care unit: a randomized clinical trial

Abstract

Noninvasive ventilation (NIV) is recommended as a preventive intervention to minimize postextubation respiratory insufficiency in patients considered high-risk for extubation failure. This study aims to compare the efficacy of High-velocity nasal insufflation (HVNI) and High-flow nasal cannula (HFNC) initiated immediately postextubation versus NIV in lowering weaning failure rates in high-risk ventilated patients. Patients who were admitted to the respiratory intensive care unit and were considered highly vulnerable to extubation failure, underwent random distribution to receive ventilatory support following extubation and stratified into group A (HFNC), group B (HVNI), or group C (NIV). Patients were monitored clinically and in the laboratory. Both ICU and hospital outcomes were additionally assessed across three groups. Postextubation, all three arms of the study were comparable with respect to oxygen requirements and postextubation oxygen saturation (SpO 2 ). SpO 2 /FiO 2 , respiratory rate and the ratio of SpO 2 /fraction of inspired oxygen (FiO 2 ) to respiratory rate (ROX index) values at 1 h and 6 h postextubation were comparable. Treatment failure assessment among studied groups at 72 h showed insignificant differences. NIV did not show physiological superiority and was associated with increased device-related adverse effects and patient discomfort, while HFNC and HVNI were associated with fewer adverse effects and more patient comfort. Acute Physiology and Chronic Health Evaluation II score, C-reactive protein, and neutrophil-to-lymphocyte ratio independently predicted weaning failure. HFNC and HVNI represent effective and better-tolerated alternatives to NIV for postextubation respiratory support, with similar short-term clinical outcomes.