Effects of high-flow oxygen therapy on patients with hypoxemia after extubation and predictors of reintubation: a retrospective study based on the MIMIC-IV database

Abstract Background To investigate the indications for high-flow nasal cannula oxygen (HFNC) therapy in patients with hypoxemia during ventilator weaning and to explore predictors of reintubation when treatment fails. Methods Adult from mechanical ventilation were identified Medical Information Mart Intensive Care IV (MIMIC-IV) database. The assigned group or control according whether they receiving HFNC non-invasive (NIV) after extubation. 28-day mortality rates compared between two groups Propensity score matching (PSM). predictor was formulated risk factors XGBoost algorithm. areas under receiver operating characteristic curve (AUC) calculated prediction values at 4 h extubation, which ratio SpO 2 /FiO respiratory rate (ROX index). Results A total 524,520 medical records screened, 801 moderate severe undergoing included (100 < PaO2/FiO2 ≤ 300 mmHg), including 358 who received extubation group. There 315 200 mmHg) before 190 remained median oxygenation index 166[157,180] mmHg PSM. no significant differences (all P > 0.05). Then HR/SpO as a 48-h important features predicting failure. According AUC 0.657, larger than that ROX (0.583). When reached 1.2 specificity 93%. Conclusions effect is not inferior NIV, even on 160 180 ventilator. more early accurate failure index.