High-flow nasal cannula (HFNC) was found to be noninferior to noninvasive positive pressure ventilation (NPPV) for the prevention of reintubation in patients with heart failure, according to study results published in Canadian Respiratory Journal.

HFNC is noninferior to NPPV after postcardiothoracic surgery for the prevention of extubation failure, but it is unclear if this is the case in patients with heart failure.

The data of 104 patients with left ventricular ejection fraction <50% (median, 34.1%) were examined (n=58 and n=46 receiving prophylactic HFNC and NPPV, respectively). The primary outcome of interest was treatment failure within 72 hours, defined as escalation from HFNC to a different respiratory device or the need for invasive mechanical ventilation in patients who received NPPV. Secondary outcomes included reintubation with 72 hours, reintubation, length of hospital and intensive care unit stay, and hospital and intensive care unit mortality.

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Treatment failure within 72 hours occurred in 25.9% and 13% of patients who received HFNC and NPPV, respectively (P =.106). The rate of hypoxemic respiratory failure within 72 was lower in the NPPV group (16.7%) compared with the HFNC group (73.3%; P =.046). There was no significant difference in the rate of occurrence of any of the secondary outcomes.

Of the 15 patients who received HFNC and experienced treatment failure within 72 hours, 8 required reintubation, and 7 were escalated to NPPV as rescue therapy, which was unsuccessful on 2 of those patients.  

Study limitations include its retrospective nature which may have resulted in potential selection biases.

“In critically ill patients with heart failure, there was no significant difference in the effectiveness of prophylactic HFNC in preventing extubation failure compared with NPPV,” the study authors concluded.


Chang CJ, Chiang LL, Chen KY, Feng PH, Su CL, Hsu HS. High-flow nasal cannula versus noninvasive positive pressure ventilation in patients with heart failure after extubation: An observational cohort study. Can Respir J. 2020;2020:6736475. doi:10.1155/2020/6736475