Tailored Predictive Indicators for Weaning Success from High-Flow Nasal Cannula in Postoperative Hypoxemic Patients

The use of high-flow nasal cannula (HFNC) as an oxygen therapy post-extubation has demonstrated varying success rates across different surgical populations. This study aimed to identify the predictive factors influencing HFNC weaning outcomes in patients with postoperative extubation hypoxemia. We conducted a retrospective analysis of patients in a surgical intensive care unit, categorized into three major postoperative groups: cardiothoracic surgery, upper abdominal surgery, and other surgeries. Our analysis examined pre-extubation weaning profiles, vital signs before and after HFNC initiation, and changes in physiological parameters during HFNC use. A total of 90 patients were included, divided into two groups based on HFNC weaning success or failure. Key parameters analyzed included maximal inspiratory pressure (MIP), PaO₂/FiO₂ (P/F) ratio, vital signs, SpO₂ levels, respiratory rate (RR), heart rate (HR), respiratory rate-oxygenation (ROX) index, and HFNC duration. The findings revealed that cardiothoracic and upper abdominal groups showed significantly higher HFNC weaning success rates (73.3% and 70.6%) compared to the other surgeries group (34.6%) (p = 0.004). Critical predictors of successful weaning included pre-HFNC SpO₂, P/F ratio, and changes in the ROX index, particularly in upper abdominal and other surgeries groups. In cardiothoracic surgery patients, higher maximal inspiratory pressure (MIP) (p = 0.031) was associated with improved outcomes, while prolonged HFNC use correlated with weaning success in this group (p = 0.047). These findings underscore the necessity of tailoring HFNC strategies to surgical characteristics and individual patient profiles. For cardiothoracic surgery patients, pre-extubation MIP, post-extubation RR, ΔROX, and ΔHR were identified as key predictive factors. In upper abdominal surgery, pre-extubation P/F ratio, post-extubation SpO₂, and ΔROX played crucial roles. For patients undergoing other types of surgeries, pre-extubation P/F ratio and ΔROX remained the most reliable predictors of HFNC weaning success.