ROLE OF LOW-FLOW VS. HIGH-FLOW OXYGEN THERAPY POST-EXTUBATION IN ICU PATIENTS

Abstract

The post-extubation period is a high-risk time for respiratory compromise in critically ill adults, and careful oxygen therapy selection is required. Low-flow oxygen therapy (LFOT) is commonplace due to its ease and low cost, but it is not humidified and does not deliver constant FiO₂, “which may compromise its clinical effectiveness. High-flow nasal cannula (HFNC) has been proposed as a more effective alternative, delivering heated, humidified oxygen at high flow rates with low-level positive airway pressure. Nevertheless, its wider application is controversial secondary to increased expense and paucity of data guiding routine use in overall ICU populations without established risk stratification. This trial compared the efficacy of HFNC versus LFOT in adult ICU patients following extubation. It meta-analyzed data from 26 peer-reviewed articles, including randomized controlled trials, cohort studies, and systematic reviews, involving 8,537 patients. Outcomes were categorized into efficacy (reintubation rates, oxygenation), patient-oriented measures (comfort, adherence), and healthcare use (ICU length of stay, equipment expenditures). HFNC drastically decreased reintubation rates in high-risk patients and enhanced both early oxygenation and patient comfort, especially during the first 24–48 hours after extubation. While HFNC was associated with more expensive daily equipment, there is evidence that decreases in ICU length of stay and reintubation can offset these expenses. Findings were less uniform within low-risk or unstratified populations, lending support to a selective as opposed to routine strategy. This review emphasizes the value of risk-directed oxygen therapy strategies and identifies HFNC as a safe and effective modality for enhancing outcomes in properly selected post-extubation ICU patients.