Postextubation High-flow Therapy vs Noninvasive Ventilation in Obese or at High-risk Patients
Postextubation High-flow Therapy vs Noninvasive Ventilation in Obese or at High-risk Patients
The main aim is to demonstrate whether reintubation rate is lower with preventive conditioned
 noninvasive ventilation (NIV) rather than with High-flow oxygen therapy (HFOT) in obese
 intermediate-risk patients and in high-risk patients.
Inclusion Criteria:

 1. High-Risk Patients: Patients under mechanical ventilation for more than 24 hours
 considered at high risk according to the presence of more than 3 of the following risk
 factors:

 -  >65 years.

 -  Cardiac failure as the primary indication of mechanical ventilation.

 -  Moderate to severe chronic obstructive pulmonary disease.

 -  APACHE II >12 points the extubation day.

 -  Body mass index >30.

 -  Inability to manage respiratory secretions.

 -  Not simple weaning.

 -  More than 1 comorbidity.

 -  More than 7 days under mechanical ventilation.

 -  Hypercapnia during the spontaneous breathing trial.

 -  Airway patency problems.

 2. Obese Intermediate Risk Patients: Patients under mechanical ventilation for more than
 24 hours with a Body mass index >30 and considered at intermediate risk according to
 the presence of less than 3 of the following risk factors:

 -  >65 years.

 -  Cardiac failure as the primary indication of mechanical ventilation.

 -  Moderate to severe chronic obstructive pulmonary disease.

 -  APACHE II >12 points the extubation day.

 -  Inability to manage respiratory secretions.

 -  Not simple weaning.

 -  More than 1 comorbidity.

 -  More than 7 days under mechanical ventilation.

 -  Airway patency problems.

 Exclusion Criteria:

 -  <18 years.

 -  Thacheotomized patients.

 -  Contraindications for NIV (recent facial or cervical trauma/surgery, active
 gastro-intestinal bleeding, lack of cooperation).

 -  Unscheduled extubation.

 -  Do not reintubate orders.

 -  No informed consent.