High-flow nasal cannula oxygen during breaks from noninvasive ventilation after extubation: an observational study.

Authors

Arnaud W Thille, Louis Chamblet, Stéphanie Ragot, Arnaud Gacouin, Mai-Anh Nay, Stephan Ehrmann, Christophe Girault, Laurence Dangers, Guylaine Labro, Emmanuel Canet, Jean-Pierre Quenot, Maxens Decavele, Christophe Guitton, Gwenael Prat, Clément Saccheri, Damien Contou, Anahita Rouze, Marie-Ange Azais, Antoine Romen, Guillaume Lacave, Alexandre Lautrette, Nicholas Sedillot, Romain Sonneville, Emmanuel Vivier, Marie-Anne Hoppe, Jeremy Bourenne, François Beloncle, Rémi Coudroy, Jean-Pierre Frat

Published in

Intensive care medicine. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Clinical practice guidelines recommend prophylactic noninvasive ventilation (NIV) after extubation in high-risk patients. The effects of high-flow nasal cannula (HFNC) oxygen during breaks from NIV after extubation have been poorly explored. Our objective was to assess whether HFNC rather than standard oxygen during breaks from NIV may prevent extubation failure.
Observational study based on two multicenter clinical trials including patients at high-risk of extubation failure (> 65 years or with underlying cardiac or respiratory disease). We included the 1077 patients who received prophylactic NIV after extubation, alternating with HFNC (NIV/HFNC) or standard oxygen (NIV/O₂). The primary outcome was the proportion of patients who failed extubation (reintubation or death within the seven days following extubation). We used G-computation to estimate the causal effect of HFNC on the risk of extubation failure, while accounting for confounding factors.
After extubation, 655 patients (61%) received NIV/HFNC while 422 (39%) received NIV/O₂. The extubation failure rate at day 7 was significantly lower with NIV/HFNC than with NIV/O₂ (13.7% vs. 18.5%; difference, - 4.7% [95% CI, - 9.4% to - 0.3%]; p = 0.036). Using G-computation, NIV/HFNC was not more effective than NIV/O₂ in reducing the risk of extubation failure, with an estimated adjusted difference of - 3.9% [95% CI, - 8.7% to 0.9%]. Reintubation rates were significantly lower with NIV/HFNC than with NIV/O₂ at 48h, but did not significantly differ beyond 48h.
Although the adjusted analysis did not confirm the favorable unadjusted findings, HFNC during breaks from NIV might decrease the risk of extubation failure, and warrants future clinical trials.

PMID:
42440109
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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