High-flow oxygen therapy in comparison with low-level pressure support ventilation for spontaneous breathing trials: A two-center, non-inferiority, randomized controlled study.
Apinut Jaroonpipatkul, Pichaya Kaeoperm, Nattapol Promlee et al.
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In 30 seconds
This two-centre, open-label, non-inferiority randomised controlled trial compared high-flow oxygen therapy (HFOT) with low-level pressure support ventilation (PSV) during 30-minute spontaneous breathing trials (SBTs) in adults mechanically ventilated for at least 24 hours and considered ready to wean. SBT success was 77/81 patients (95.1%) in each group; the absolute difference was 0.0% (95% CI -7.2 to 7.2), meeting the prespecified non-inferiority criterion. Extubation and 48-hour reintubation rates did not differ significantly. Hospital mortality was lower in the HFOT group, an exploratory outcome.
Key findings
- SBT success was 77/81 patients (95.1%) in each arm; absolute difference 0.0% (95% CI -7.2 to 7.2; p = 1.000).
- Extubation rates after successful SBT were 88.3% with HFOT and 80.5% with low-level PSV (p = 0.183).
- Reintubation within 48 hours occurred in 8.8% with HFOT and 17.7% with low-level PSV (p = 0.140).
- Hospital mortality was 11.1% with HFOT and 24.7% with low-level PSV (difference -13.6%; 95% CI -25.2 to -2.0; p = 0.024).
Why it matters
SBT method is part of ventilator weaning, and these results indicate that HFOT delivered through an endotracheal-tube connector can achieve SBT success comparable to low-level PSV in patients meeting weaning criteria. The mortality difference is notable but comes from an exploratory outcome and should not be interpreted as proof that HFOT reduces mortality.
What to keep in mind
The trial was open-label and conducted at two centres. The mortality outcome was exploratory, and the abstract does not report longer-term outcomes.