Nimisha S Patil, Madhulika Dubey, Mohd Mustahsin, Krishna Pratap Mall, Supriya Singh
Background and aims: Weaning patients with a high risk of extubation failure off the ventilator can be challenging and associated with complications.High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have been used after extubation in various settings.This study suggests the better modality between HFNC and NIV to prevent reintubation in these patients.Patients and methods: A single-centered, prospective, randomized comparative study was conducted in the adult medical intensive care unit (ICU) of our center.A total of 150 critically ill patients with a high risk of extubation failure were randomized in a 1:1 ratio to receive either HFNC or NIV immediately after extubation for 48 hours.The rate of reintubation within 48 hours of extubation was compared between the groups.Results: The rate of reintubation within 48 hours was lower in the HFNC group than the NIV group (p = 0.041).The rate of postextubation respiratory failure after 7 days, incidence of ventilator-associated pneumonia (VAP), sepsis, intolerance to therapy, number of patients with hospital length of stay 7 days, and hospital mortality was lower in the HFNC group (p < 0.05).The incidence of nasal discomfort was lower in the NIV group (p < 0.05).The heart rate (HR) and respiratory rate (RR) were lower in the HFNC group at 1 hour and 48 hours, respectively, after extubation (p < 0.05).The partial pressure of oxygen (PaO 2 ) and mean arterial pressure (MAP) at 48 hours after extubation were higher in HFNC group (p < 0.05).Conclusion: High-flow nasal cannula performed better than NIV in preventing reintubation at 48 hours in patients with a high risk of extubation failure.