Postextubation Management in Patients at Risk for Extubation Failure
Postextubation Management in Patients at Risk for Extubation Failure
At the time of weaning from mechanical ventilation, patients with heart and/or lung
 conditions will be given oxygen support with alternating bilevel positive airway pressure
 (BiPAP; oxygen via face mask) and heated high flow nasal cannula oxygen (HFNC; oxygen via
 nasal cannula) to see if this method reduces the likelihood of re-intubation.
It is clinically challenging to predict when patients can be successfully removed from
 mechanical ventilation (MV). Liberating high-risk patients such as the elderly and those with
 complex, chronic cardiac or pulmonary diseases from MV is particularly challenging.

 Evidence from randomized trials and meta-analyses suggests that the type of postextubation
 supportive care provided, such as oxygen delivery via nose or mouth, may affect the risk of
 reintubation. However, it is unclear which of many possible postextubation management
 protocols results in the best patient outcomes, particularly for this subset of high-risk
 patients.

 The purpose of this study is therefore to assess a standardized combined protocol of
 postextubation oxygen delivery consisting of early, alternating BiPAP with HFNC over 24 hours
 following extubation. BiPAP and HFNC are both currently provided to patients as standard of
 care, based on clinician judgement; however, the timing and nature of the methods are
 variable.
Inclusion Criteria:

 -  Documented high-risk factors of interest [congestive heart failure (CHF), chronic
 obstructive pulmonary disease (COPD), and/or positive fluid balance]

 -  The modified rapid shallow breathing index on day of extubation must be between 58-105
 breaths per minute per liter (breaths/min/L)

 -  Patient must successfully complete spontaneous breathing trial and be determined
 eligible for extubation

 -  Only primary extubations will be included

 Exclusion Criteria:

 -  Undergoing terminal extubation or placed on comfort care

 -  Home ventilator use

 -  Any contraindication that would preclude the postextubation protocol (e.g., facial
 trauma, tracheotomy, or any other reason that would preclude use of BiPAP or HFNC)