• Sophia Butt, Laura Pistidda, Leda Floris, Corrado Liperi, Francesco Vasques, Guy Glover, Nicholas A Barrett, Barnaby Sanderson, Salvatore Grasso, Manu Shankar-Hari, and Luigi Camporotaa.
• Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK. Electronic address: sophia.c.butt@gmail.com.
• J Crit Care. 2021 Jun 1; 63: 40-44.

PurposeHigh flow nasal cannula (HFNC) is commonly used post-extubation in intensive care (ICU). Patients' comfort during HFNC is affected by flow rate. The study aims to describe the relationship between pre-extubation inspiratory flow requirements and the post-extubation flow rates on HFNC that maximises patient's comfort.MethodsThis was an observational, retrospective study conducted in a university-affiliated ICU. We included patients extubated following successful spontaneous breathing trial (SBT). During the SBT we recorded variables including inspiratory flow. Patients who passed the SBT were extubated onto HFNC. HFNC was titrated from 20 L/min and increased in steps of 10 L/min, up to 60 L/min. At each step, patient's level of comfort was assessed. Fraction of inspired oxygen was titrated to maintain oxygen saturation 92-97%.ResultsNineteen participants were enrolled in the study. There was a significant positive correlation between mean inspiratory flow pre-extubation and the flow setting on HFNC which achieved the best comfort post-extubation (r2 0.88; p < 0.001). Overall, greatest comfort was observed for HFNC flows between 30 and 40 L/min but with individual variability.ConclusionMeasuring mean inspiratory flow during an SBT allows for individualised setting of HFNC flow rate immediately post-extubation and achieves the greatest comfort and interface tolerance.Copyright © 2021 Elsevier Inc. All rights reserved.

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