Preventive post-extubation high-flow nasal oxygen therapy versus non-invasive ventilation: a substitutive or a complementary ventilatory strategy?
Endotracheal mechanical ventilation (MV) is a major treatment of life-threatening conditions, but weaning from MV remains a great challenge, and time of extubation a critical issue in the intensive care unit (ICU) management (1,2). ICU clinicians have to clearly distinguish the weaning phase from extubation period to best identify their respective mechanisms and risk factors for failure. Indeed, weaning difficulties [failure of one or more spontaneous breathing trial (SBT)] occur in 19% of ICU patients according to a recent new definition of weaning outcome, and ICU mortality can reach up to 21% in these patients (3). Despite a SBT success, extubation failure can occur in 10% to 20% of cases with a higher ICU mortality rate in reintubated patients ranging from 25% to 50% (2). Hence, ICU physicians should consider the potential issue of the weaning/extubation process as early as possible according to the underlying status for optimizing the weaning/extubation conditions, limit the risk of reintubation and eventually propose alternative techniques for post-extubation management (1).