High-Flow Nasal Cannula Application After Extubation in Acute Respiratory Failure Patients

<b>Background:</b> The optimal timing of high-flow nasal cannula (HFNC) application in acute respiratory failure patients remains uncertain. This study aimed to investigate the impact of HFNC on the outcomes of patients with acute respiratory failure, focusing on its use after extubation. <b>Methods:</b> This multicenter retrospective study enrolled adult acute respiratory failure patients requiring invasive mechanical ventilation during the first major outbreak of the COVID-19 pandemic in Taiwan from April to July 2021. Endpoints included prognosis after extubation as 28-day post-extubation mortality. <b>Results:</b> Among the patients, 107 received HFNC before intubation and 461 received conventional oxygen therapy (COT). Pre-intubation HFNC failure did not significantly affect hospital mortality but was associated with prolonged durations of mechanical ventilation and intensive care unit stay. Among 375 patients who underwent planned extubation, 158 received post-extubation HFNC and 217 received COT. HFNC application after extubation was associated with significantly reduced post-extubation 28-day mortality compared with COT. <b>Conclusions:</b> HFNC application after extubation is associated with reduced post-extubation 28-day mortality risks in acute respiratory failure patients who received planned extubation.