Oxygenation strategies after extubation of critically ill and postoperative patients

In intensive care units (ICUs), the decision to extubate is a critical one because mortality is particularly high in case of reintubation. Around 15% of patients ready to be weaned off a ventilator experience extubation failure leading to reintubation. The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation. High-flow nasal oxygen and non-invasive ventilation, may be used to prevent reintubation in patients with low (e.g., patients without comorbidities and with short durations of mechanical ventilation) and high risk (e.g., patients >65 years and those with underlying cardiac disease, chronic respiratory disorders, and/or hypercapnia at the time of extubation) of reintubation, respectively. However, non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation, and should therefore be used very carefully in this setting. The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs. Standard oxygen after a surgical procedure is adequate, even following major abdominal or cardiothoracic surgery, but should probably be switched to high-flow nasal oxygen in patients with hypoxemic. Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects, it may actually improve the outcomes in postoperative patients with respiratory failure. This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.