Clinical trial NCT06301035: Asymmetric High-flow Nasal Cannula (HFNC) vs Standard HFNC for Post Extubation High-risk Group
Official title: Comparison of Asymmetric High-flow Nasal Cannula (HFNC) and Standard HFNC in Post Extubation High-risk Group: A Prospective, Single-center, Open-labeled, Randomized Controlled Pilot Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Acute Respiratory Failure
Keywords: High flow nasal cannula
Electrial impedance tomography
Lead sponsor: Samsung Medical Center
Sponsor class: OTHER
Collaborators: name: Fisher and Paykel Healthcare
First posted: 2024-03-08
Enrollment: 30
Sex: ALL
Minimum age (years): 19
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Background The exacerbation of respiratory failure that occurs after endotracheal intubation often occurs in patients who have received mechanical ventilation therapy, and when it occurs, it emerges as an important issue to consider reintubation of endotracheal intubation. High-flow nasal cannula (HFNC) through nasal cannula is known to produce positive airway pressure and deliver a certain amount of oxygen, and recently reported clinical studies have demonstrated the effect of lowering the risk of reintubation after endotracheal intubation, which is recommended for use in recent clinical practice guidelines. However, in patients at high risk of intubation failure, the combination of high-flow oxygen therapy and non-invasive positive-pressure ventilation therapy rather than the application of high-flow oxygen therapy alone through nasal cannula is helpful in reducing the rate of reintubation of endotracheal intubation. However, an alternative to non-invasive positive-pressure ventilation therapy is needed as there is a possibility of complications such as aspiration pneumonia, maladaptation of the application device (mask), and discomfort, making it difficult to apply it in the field.

Recently, it has been reported that high flow oxygen therapy through an asymmetric nasal cannula forms sufficient positive pressure in terms of respiratory dynamics, which makes the patient feel comfortable and reduces work of breath. However, no clinical studies have yet compared physiological effects using this method in patients at high risk of extubation failure.

Goal The investigators would like to compare the physiological effects of high flow oxygen therapy through 'asymmetric nasal cannula' with high flow oxygen therapy through 'standard nasal cannula' in patients identified as high-risk groups for valvular failure.

Hypothesis 'Asymmetric nasal cannula' reduces work of breath compared to 'standard nasal cannula' in high-risk patients with valvular failure.


Eligibility criteria: Inclusion Criteria:

1. 19 years of age or older
2. Patients who applied mechanical ventilation treatment for more than 24 hours before the excision
3. Patients who underwent endotracheal intubation rather than tracheal incision
4. Planned extubation after successful spontaneous breathing trial (SBT)
5. Reintubation High Risk Patients: If any of the following conditions are met

   1. Age \> 65
   2. Acute Physiology and Chronic Health Evaluation(APACHE) II on the day of extubation \> 12
   3. Body mass index (BMI) \> 30 kg/m2
   4. Inability to deal with respiratory secretions

      * improper cough reflex
      * If at least three aspirations are required in the 8 hours prior to the discharge
   5. Difficult or long delay in mechanical ventilation

      * The first attempt to leave the mechanical ventilation failed
   6. Charlson Commercial Index (CCI) at least 2 categories of comorbidities
   7. Heart failure is the main indication of mechanical ventilation application
   8. Moderate to severe chronic obstructive pulmonary disease
   9. If there is a problem with airway openness (high risk of developing laryngeal edema)

      * a woman
      * Oral endotracheal intubation maintenance period of at least 3 days
      * Difficult to intubate endotracheally (difficult airway)
   10. Long-term mechanical ventilation application: When applied for more than 7 days

Exclusion Criteria:

1. a patient with a tracheostomy tube
2. Contraindicated application of nasal interfaces

   * a nasal disorder
3. Continuous positive pressure (CPAP) application contraindications

   * pneumothorax, blistering lung disease, head trauma, cranial facial surgery, airway foreign matter, unstable hemodynamics, etc
4. EIT application contraindications

   * Patients using implantable electronic medical devices (such as implantable defibrillators, pacemakers or spinal cord stimulators)
   * a patient with hyperhidrosis
   * a patient whose physical movements are not controlled
   * a pregnant woman
   * BMI 50 or higher

Primary outcomes:
measure: Respiratory Rate Oxygenation (ROX) Index
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
Secondary outcomes:
measure: The Lowest value of SpO2 within 24 hours after extubation
timeFrame: within 24 hours after extubation
measure: PaO2/FiO2
timeFrame: 30 minutes, 6 hours, 24 hours
measure: SpO2/FiO2
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: changes of end-expiratory lung impedance, at each flow rate measured through Electrical Impedance tomography (EIT)
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: Changes in non-homogeneity indicators measured through EIT (changes in Global homeogeneity index)
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: Respiratory rate
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: work of breath (Modified Borg Scale, MBS)
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: systolic blood pressure
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: mean arterial pressure
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: heart rate
timeFrame: 1 hour, 2 hours, 6 hours, 12 hours, 24 hours
measure: Rate of reintubation within 7 days
timeFrame: within 7 days after extubation
measure: Length of ICU stay
timeFrame: From date of ICU admission until the date of ICU discharge, assessed up to 2 years
measure: Length of hospital stay
timeFrame: From date of hospital admission until the date of hospital discharge, assessed up to 2 years
measure: ICU Mortality
timeFrame: From date of extubation until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 1 year
measure: Hospital Mortality
timeFrame: From date of extubation until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 1 year
measure: 28 Day Mortality
timeFrame: From date of extubation until the date of 28 Day or date of death from any cause, whichever came first, assessed up to 1 months
measure: 90 Day Mortality
timeFrame: From date of extubation until the date of 90 Day or date of death from any cause, whichever came first, assessed up to 3 months
Other outcomes:
Locations:
city: Seoul
country: Korea, Republic of
facility: Samsung Medical Center
Study officials:
References:
citation: Hernandez G, Vaquero C, Colinas L, Cuena R, Gonzalez P, Canabal A, Sanchez S, Rodriguez ML, Villasclaras A, Fernandez R. Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA. 2016 Oct 18;316(15):1565-1574. doi: 10.1001/jama.2016.14194.
citation: Thille AW, Muller G, Gacouin A, Coudroy R, Decavele M, Sonneville R, Beloncle F, Girault C, Dangers L, Lautrette A, Cabasson S, Rouze A, Vivier E, Le Meur A, Ricard JD, Razazi K, Barberet G, Lebert C, Ehrmann S, Sabatier C, Bourenne J, Pradel G, Bailly P, Terzi N, Dellamonica J, Lacave G, Danin PE, Nanadoumgar H, Gibelin A, Zanre L, Deye N, Demoule A, Maamar A, Nay MA, Robert R, Ragot S, Frat JP; HIGH-WEAN Study Group and the REVA Research Network. Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial. JAMA. 2019 Oct 15;322(15):1465-1475. doi: 10.1001/jama.2019.14901.
citation: Slobod D, Spinelli E, Crotti S, Lissoni A, Galazzi A, Grasselli G, Mauri T. Effects of an asymmetrical high flow nasal cannula interface in hypoxemic patients. Crit Care. 2023 Apr 18;27(1):145. doi: 10.1186/s13054-023-04441-6.
citation: Tan D, Walline JH, Ling B, Xu Y, Sun J, Wang B, Shan X, Wang Y, Cao P, Zhu Q, Geng P, Xu J. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Crit Care. 2020 Aug 6;24(1):489. doi: 10.1186/s13054-020-03214-9.
citation: Hernandez G, Paredes I, Moran F, Buj M, Colinas L, Rodriguez ML, Velasco A, Rodriguez P, Perez-Pedrero MJ, Suarez-Sipmann F, Canabal A, Cuena R, Blanch L, Roca O. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med. 2022 Dec;48(12):1751-1759. doi: 10.1007/s00134-022-06919-3. Epub 2022 Nov 18.
citation: Tatkov S, Rees M, Gulley A, van den Heuij LGT, Nilius G. Asymmetrical nasal high flow ventilation improves clearance of CO2 from the anatomical dead space and increases positive airway pressure. J Appl Physiol (1985). 2023 Feb 1;134(2):365-377. doi: 10.1152/japplphysiol.00692.2022. Epub 2023 Jan 12.