# Temporal trends in post-extubation respiratory management and reintubation risk factors in Japan: A retrospective multicenter cohort study

## TL;DR

This study analyzed how the use of non-invasive ventilation and high-flow nasal cannula changed after extubation in Japan from 2018 to 2022.

## Contribution

The study reveals a significant shift in post-extubation respiratory management practices in Japanese ICUs over five years.

## Key findings

- The use of non-invasive ventilation decreased significantly from 2018 to 2022.
- High-flow nasal cannula use increased significantly during the same period.
- Multivariable analysis confirmed these trends remained significant.

## Abstract

Non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) have been used to prevent reintubation. We aimed to describe the utilisation patterns and analyze temporal trends of NIV and HFNC after extubation.

Retrospective multicenter cohort study using the Japanese Intensive care PAtient Database (JIPAD) from 2018 to 2022.

Facilities that consecutively registered cases in JIPAD during the study period.

We included adult patients (>18 years) who were receiving mechanical ventilation at the time of intensive care unit (ICU) admission, with a duration of mechanical ventilation of at least 24 h.

None.

Temporal trends in the utilisation of NIV and HFNC after extubation over the 5-year study period.

We included 12,687 eligible patients from 40 ICUs. Based on the Cochran–Armitage test, the proportion of patients receiving NIV decreased from the years 2018 to 2022 (6.7-3.9 %, P for trend <0.001), while that receiving HFNC significantly increased (15.9-28.0 %, P for trend <0.001). After multivariable adjustment (with 2018 as the reference year) and relative to oxygen therapy, the year 2022 was associated with a significant decrease in NIV (adjusted odds ratio, 0.67; 95 % confidence interval, 0.52-0.88) and a significant increase in HFNC (adjusted odds ratio, 1.89; 95 % confidence interval, 1.62-2.21).

We analysed over 12,000 patients in this retrospective multicenter cohort study. The proportion of HFNC use after extubation increased, while NIV use decreased, and these changes remained significant after multivariable analysis. Further research is warranted to clarify appropriate indications for NIV and HFNC after extubation.