High-Flow Versus VenturiMask Oxygen Therapy to Prevent Re-Intubation in Hypoxemic Patients After Extubation: A Multicenter, Randomized Clinical Trial

Rationale: When compared to VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. Objective: To establish whether high-flow oxygen prevents endotracheal re-intubation in hypoxemic patients after extubation, as compared to VenturiMask. Methods: In this multicentre randomized trial, 494 patients exhibiting PaO2:FiO2 ratio≤300 mmHg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before re-intubation. High-flow use in VenturiMask group was not permitted. Measurements and main results: The primary outcome was the rate of re-intubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included re-intubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n=492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required re-intubation at 72 hours (unadjusted odds ratio 1.26 [95%CI 0.70-2.26], p=0.49). At 28 days, the rate of re-intubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio 0.89 [95%CI 0.60-1.31], p=0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% vs. 17%, adjusted hazard ratio 0.39 [95%CI 0.22- 0.71], p=0.002; at 28 days, 12% vs. 21%, adjusted hazard ratio 0.52 [95%CI 0.32-0.83], p=0.007. Conclusions: Re-intubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded to less frequent use of rescue noninvasive ventilation.