Showing posts with label extubation. Show all posts
Showing posts with label extubation. Show all posts

Tuesday, July 23, 2019

HFNC vs. conventional oxygen after extubatio

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One of the dreaded things in Critical Care is to extubate someone and see that they’re not flying. It makes you question yourself; your judgement, assessments. It makes you self conscious. Will families may lose trust in you, and most importantly: are you causing harm to your patients? I’ve had just 6 reintubations in my 2 years out of training but that is considered too few as the reintubation rate should be 10-15%. Otherwise you’re not being aggressive enough. I don’t even check blood gases before I pull the tube. Needless to say, my kickass RT’s know that for the questionable pts, I want the #BiPAP or #HFNC at the bedside when we pull the tube. Sometimes hooked up and ready to go, sometimes outside the room to “ward off evil spirits”. I have a plan A, B, and C ready to go before I reintubate. My empiric data, otherwise worthless, shows that HFNC does help prevent reintubation. This meta-analysis says different. My bias, admittedly, says the conclusion has some limitations, and if you seek you shall find. This is an issue with meta analyses, the heterogeneity. You’re trying to compare apples and oranges regarding different studies and the authors did the best they could with statistical gymnastics that I don’t quite understand to make apple pie with an orange flavored crust. It just didn’t work out to show certain endpoints bc the included studies were just too different. Does that means that HFNC really doesn’t help avoid reintubations? Nope. It just means we need more data. A big 🎩 tip to the authors. 

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