• Atsushi Ishihara, Hideshi Okada, Teruki Mori, Takashi Yoshizane, Kentaro Morishita, Takuji Yamamoto, Izumi Toyoda, and Toshiyuki Noda.
• Department of Respiratory Support Center, Gifu Prefectural General Medical Center, Gifu, Japan. Electronic address: g.a.ishihara@gmail.com.
• J Crit Care. 2024 Oct 1; 83: 154840154840.

PurposeThis study aimed to evaluate the impact of early high-flow nasal oxygen (HFNO) therapy initiation using a pre-determined respiratory rate‑oxygenation (ROX) index on reducing reintubation rates and duration of intensive care unit (ICU) stay in post-extubated patients.Materials And MethodsWe enrolled a total of 145 extubated patients (mean age: 67.1 ± 12.9 years; sex: 96 male and 49 female; acute physiology and chronic health evaluation II score: 18.4 ± 6.8 points) classified into two groups: 71 patients admitted to the ICU before establishing extubation criteria and 74 patients after criteria implementation, over a 6-month period. We compared the HFNO reintubation rates and ROX index at 2 h post-extubation before and after implementing early HFNO criteria.ResultsThe utilization rate of HFNO pre- and post-establishment of early HFNO criteria did not differ significantly (19.7% vs. 17.6%). However, the reintubation rate significantly decreased (11.3% vs. 4.1%, P < 0.05) with early HFNO use. Additionally, significant differences were observed in the total intubation period (5.2 ± 7.0 vs. 2.5 ± 2.7 days, P < 0.05) and ICU duration (8.6 ± 9.7 vs. 5.8 ± 5.6 days, P < 0.05).ConclusionsEarly initiation of HFNO guided by the ROX index threshold post-extubation in patients admitted to ICU is associated with reduced reintubation rates and shorter ICU stays.Copyright © 2024. Published by Elsevier Inc.

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