High Flow Nasal Cannula Versus Non Invasive Positive Pressure Ventilation in Reducing The Rate of Reintubation

Study Overview
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Brief Summary
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This is study aim to compare between high flow nasal canula (HFNC) and non invasive positive pressure ventilation (NIPPV) in reducing the rate of reintubation in mechanically ventilated patient with successful weaning

Detailed Description
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High-flow nasal cannula (HFNC) oxygen therapy comprises an air/oxygen blender, an active humidifier, a single heated circuit, and a nasal cannula. It delivers adequately heated and humidified medical gas at up to 60 L/min of flow and is considered to have a number of physiological effects: reduction of anatomical dead space, positive end expiratory pressure ( PEEP ) effect, constant fraction of inspired oxygen, and good humidification Noninvasive positive-pressure ventilation is a safe and effective means of improving gas exchange in patients with many types of acute respiratory failure . for example, adding noninvasive ventilation to standard therapy decreased the need for endotracheal intubation...For patients assigned to noninvasive ventilation, the ventilator was connected with conventional tubing to a clear, full-face mask with an inflatable soft-cushion seal and a disposable foam spacer to reduce dead space .After the mask had been secured, pressure support was increased to achieve an exhaled tidal volume of 8 to 10 ml per kilogram, a respiratory rate of fewer than 25 breaths per minute, the disappearance of accessory muscle activity (as evaluated by palpation of the sternocleidomastoid muscle), and patient comfort The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. The investigators aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV)

Official Title
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High Flow Nasal Cannula Versus Non Invasive Positive Pressure Ventilation in Reducing Reintubation in Mechanically Ventilated Patient

Conditions
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Respiratory Failure, Re-intubation Rate

Intervention / Treatment
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* Device: high flow nasal cannula
* Device: non invasive positive pressure ventilation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patient suffer from acute respiratory failure and intubated for mechanical ventilation and then extubated for weaning Age >18 years old Exclusion Criteria: In patients less than 18 years old Any contradiction in using HFNC as trauma or surgery or obstruction of nasopharynx Any contradiction in using NIPPV as facial trauma ..surgery ..deformity..or upper airway obstruction or upper gastrointestinal bleeding or high risk of aspiration

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: When the patient become weanable from mechanical ventilation, the subjects were extubated immediately and randomly divided into two groups, with one group receiving HFNC (called HFNC group), the other group receiving NIPPV (called NIPPV group)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: high flow nasal cannula group<br>patients put on high flow nasal cannula after extubation | Device: high flow nasal cannula<br>* device are used for weaning patients after mechanical ventilation extubation<br>|
| Active Comparator: non invasive positive pressure ventilation group<br>patients put on non invasive positive pressure ventilation group after extubation | Device: non invasive positive pressure ventilation<br>* device are used for weaning patients after mechanical ventilation extubation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the need for re-intubation and weaning success which will be measured by arterial blood gas ( ABG ) |  | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of using of HFNC or NIPPV |  | up to 30 days | 
| Length of hospital stay measured by days |  | up to 30 days | 
| In - hospital mortality measured by number of died cases |  | up to 30 days | 
| Adverse events | Adverse events (occurrence of nosocomial pneumonia based on clinical and laboratory and radiological finding, need for MV measured by re-intubation rate) | up to 30 days | 
| Incidence of any possible complications associated with the use of HFNC and NIPPV |  | up to 30 days |