• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Pulmonology

High-flow oxygen therapy as effective as BiPAP in preventing reintubation

byMilana Bogorodskaya, MDandPriyanka Vedak
May 20, 2015
in Pulmonology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. In this study, high flow nasal cannula (HFNC) was found to be non-inferior to bilevel positive airway pressure (BiPAP) in reducing reintubation rates after cardiothoracic surgery.

2. In this study, BiPAP had a higher rate of discontinuation per patient request than HFNC.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Acute respiratory failure is a common complication of cardiothoracic surgery. This trial sought to determine whether high-flow nasal cannula (HFNC) is just as effective as non-invasive ventilation (NIV) in preventing reintubation in post-operative patients. Results showed that HFNC was not inferior to BiPAP in reintubation rates. Oxygenation was shown to improve more with BiPAP than HFNC but arterial carbon dioxide (PaCO2) was shown to decrease faster with HFNC. BiPAP did have higher rate of discontinuation of use and of skin breakdown. There was no change in mortality rates or intensive care unit hospital days between the two modes of oxygen delivery.

Strengths of the study included the large number of participants in the trial and its construction as a non-inferiority trial. This allowed the authors to prove that HFNC was no worse than NIV without having to prove its superiority. However, the major limitation of the study was the high confidence interval margins in the study for detection of non-inferiority. Consequently, it becomes difficult to assess whether the HFNC was truly non-inferior, as it could also be inferior and superior based on the wide confidence interval margins.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

RELATED REPORTS

Nasal high-flow therapy improves likelihood of neonatal intubation

#VisualAbstract: Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation

Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation

Relevant Reading: Early noninvasive ventilation averts extubation failure in patients at risk

In-Depth [randomized controlled trial]: This study was a multicenter, randomized, non-inferiority trial that recruited 830 patients across 6 centers in France who had undergone cardiothoracic surgery and met one of the following criteria: 1) failed a spontaneous breathing trial (SBT), 2) had a successful SBT but had preexisting risk factors for post-extubation acute respiratory failure (e.g., BMI>30, LVEF<40%, prior failure to extubate), or 3) had a successful SBT followed by a failed extubation. Patients were randomized either to receive HFNC with initial FiO2 of 50% or BiPAP at an inspiratory positive airway pressure of 8 and expiratory positive airway pressure of 4, and FiO2 of 50%, with the settings of both titrated to achieve a SaO2 of 92% or higher. HFNC was discontinued if the PaO2:FiO2 ratio was ≥300 and BiPAP was discontinued when patient required it less than 4 hours a day. Reintubation, early treatment discontinuation, or changing of treatment was defined as a failure. Results showed that HFNC was not inferior to BiPAP, with a 21.9% failure rate in the HFNC group and a 21.0% failure rate in the BiPAP group (absolute difference 0.9%; 95%CI -4.9% to 6.6%; p = 0.003 for non-inferiority). Premature discontinuation of therapy was higher in the BiPAP group (with 3.6% rate for BiPAP vs. 1.6% rate for HFNC; p = 0.04). There was no difference in failure rates between the two modes of oxygen delivery in severely hypoxic patients.

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: intubationpositive pressure ventilation
Previous Post

Stereotactic radiosurgery may effectively treat facial nerve schwannoma

Next Post

Drug ameliorates effects of chronic kidney disease by targeting cell cytoskeleton [PreClinical]

RelatedReports

Low evidence for glycerin use in preterm infants
Obstetrics

Nasal high-flow therapy improves likelihood of neonatal intubation

May 13, 2022
#VisualAbstract: Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation
StudyGraphics

#VisualAbstract: Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation

April 13, 2022
Quick Take: Efficacy of prehospital criteria in identifying trauma patients susceptible to undertriage
Emergency

Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation

February 24, 2022
#VisualAbstract: High-flow oxygen therapy reduces intubation requirements and decreases recovery time in severe COVID-19 infections compared to conventional oxygen therapy
StudyGraphics

#VisualAbstract: High-flow oxygen therapy reduces intubation requirements and decreases recovery time in severe COVID-19 infections compared to conventional oxygen therapy

December 15, 2021
Next Post
Intravenous contrast may not increase risk of acute kidney injury

Drug ameliorates effects of chronic kidney disease by targeting cell cytoskeleton [PreClinical]

Oral prednisone improves function, not pain in acute lumbar radiculopathy

ecoli

STOP-IT trial supports fixed-duration antibiotic therapy for intraabdominal infections

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Intravenous fluid restriction does not improve septic shock outcomes
  • Intravenous vitamin C increases mortality and organ dysfunction in sepsis patients
  • Magnetic resonance based preoperative evaluation for perianal fistulas superior to traditional clinical method and improve surgical outcomes [Classics Series]
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.