Comparison of three respiratory support methods in early post-extubation period in patients with acute respiratory distress syndrome: a prospective randomized study

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Objective. To assess the efficacy of preventive high-flow oxygenation and non-invasive ventilation in early post-extubation period compared to standard oxygen therapy in patients with ARDS. Material and methods. A prospective randomized single-center study enrolled 61 adults who received invasive mechanical ventilation for at least 24 hours and met the Berlin definition of acute respiratory distress syndrome. After successful 120-minute spontaneous breathing trial test, patients were randomized into three groups of post-extubation respiratory support: standard oxygen therapy through a face mask, high-flow oxygenation through nasal cannula or non-invasive pressure support ventilation. The active follow-up period was 48 hours with assessment of blood gases, hemodynamics, and respiratory status. The need for reintubation and its causes were recorded for 7 days. Results. All groups did not differ in age, gender, severity of organ dysfunction and ventilation time. The overall rate of reintubation within 7 days was 23% (14/61) (15% in the high-flow oxygenation and non-invasive ventilation groups, 38% in the standard oxygen therapy group). When all causes of reintubation were analyzed, we found no between-group differences (p=0.094). When non-respiratory causes were excluded, we found significantly less incidence of reintubation after high-flow oxygenation or non-invasive ventilation in early post-extubation period (p=0.033). Length of ICU- and hospital-stay, as well as mortality rate did not differ between groups. Conclusion. In patients with acute respiratory distress syndrome, preventive high-flow oxygenation or non-invasive ventilation in early post-extubation period is associated with less incidence of reintubation for respiratory causes compared to standard oxygen therapy.