title: Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome.
abstract: BACKGROUND
  Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce.
  
  
  OBJECTIVE
  To compare the effects of the Venturi mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes.
  
  
  METHODS
  Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation.
  
  
  RESULTS
  PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group.
  
  
  CONCLUSIONS
  Compared with the Venturi mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
authors.affiliation: 1 Department of Anesthesiology and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Salvatore Maurizio
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Francesco Antonio
authors.initials: FA
authors.lastname: Idone
authors.forename: Rosanna
authors.initials: R
authors.lastname: Vaschetto
authors.forename: Rossano
authors.initials: R
authors.lastname: Festa
authors.forename: Andrea
authors.initials: A
authors.lastname: Cataldo
authors.forename: Federica
authors.initials: F
authors.lastname: Antonicelli
authors.forename: Luca
authors.initials: L
authors.lastname: Montini
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007558:Italy; D008297:Male; D008397:Masks / Q000009:adverse effects / Q000706:statistics & numerical data*; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods*
keywords: extubation; high-flow oxygen therapy; oxygen therapy; patient comfort; weaning