Discomfort of noninvasive ventilation, high flow nasal cannula oxygen, and conventional oxygen implemented after extubation in non-COPD patients

BACKGROUND: Discomfort of noninvasive respiratory supports remain controversial. In the present study, the discomfort of high flow nasal cannula oxygen, noninvasive ventilation, and conventional oxygen therapy were evaluated in the post-extubation period. METHODS: Noninvasive ventilation alternating with high flow nasal cannula oxygen or conventional oxygen therapy were implemented for 48 h following extubation in patients free of chronic obstructive pulmonary disease. Using a 10-cm visual analog scale, the discomfort of the interface (oxygen mask, nasal prongs or facial mask), was self-evaluated by 264 patients after extubation whereas the discomfort of the respiratory support (conventional oxygen therapy or high flow nasal cannula oxygen alternating with noninvasive ventilation) was evaluated by the nurses in 306 patients. Evaluations were performed in patients at high (n = 127) and low (n = 179) risk of postextubation respiratory failure, 6, 24 and 48 h after extubation. RESULTS: Facial mask was the source of a significant and persisting self-evaluated discomfort. Nasal prongs and oxygen mask were less uncomfortable, with a progressive reduction of the discomfort with time. High flow nasal cannula oxygen alternating with noninvasive ventilation caused a significant and persisting nurse-reported discomfort. Conventional oxygen therapy was significantly less uncomfortable, and the degree of discomfort was not different in patients at high and low risk of extubation failure. CONCLUSIONS: Noninvasive ventilation was associated with a significant and persisting discomfort whereas high flow nasal cannula oxygen-induced discomfort remained limited. After 48 h, discomfort resulting from high flow nasal cannula oxygen and conventional oxygen therapy was similar and negligible.