Postextubation High-flow Therapy vs Noninvasive Ventilation in Obese or at High-risk Patients

Inclusion criteria

• High-Risk Patients: Patients under mechanical ventilation for more than 24 hours considered at high risk according to the presence of more than 3 of the following risk factors:

• >65 years.
• Cardiac failure as the primary indication of mechanical ventilation.
• Moderate to severe chronic obstructive pulmonary disease.
• APACHE II >12 points the extubation day.
• Body mass index >30.
• Inability to manage respiratory secretions.
• Not simple weaning.
• More than 1 comorbidity.
• More than 7 days under mechanical ventilation.
• Hypercapnia during the spontaneous breathing trial.
• Airway patency problems.
• Obese Intermediate Risk Patients: Patients under mechanical ventilation for more than 24 hours with a Body mass index >30 and considered at intermediate risk according to the presence of less than 3 of the following risk factors:

• >65 years.
• Cardiac failure as the primary indication of mechanical ventilation.
• Moderate to severe chronic obstructive pulmonary disease.
• APACHE II >12 points the extubation day.
• Inability to manage respiratory secretions.
• Not simple weaning.
• More than 1 comorbidity.
• More than 7 days under mechanical ventilation.
• Airway patency problems.

Exclusion criteria

• <18 years.
• Thacheotomized patients.
• Contraindications for NIV (recent facial or cervical trauma/surgery, active gastro-intestinal bleeding, lack of cooperation).
• Unscheduled extubation.
• Do not reintubate orders.
• No informed consent.