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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

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High-flow oxygen therapy in comparison with low-level pressure support ventilation for spontaneous breathing trials:

Apinut Jaroonpipatkul¹, Pichaya Kaeoperm², Nattapol Promlee¹

¹Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

|February 18, 2026

Abstract

Background:

Low-level pressure support ventilation (PSV) is the usual first spontaneous breathing trial (SBT) method. High-flow oxygen therapy (HFOT) via a dedicated connector through an endotracheal tube might be a credible alternative during SBT. This study aimed to compare the rate of SBT success between HFOT and low-level PSV.

Methods:

We conducted a two-centre, open-label, non-inferiority randomised controlled trial. Adults mechanically ventilated patients for at least 24 hours and ready to wean were randomised to 30-minute SBTs with HFOT or low-level PSV. The primary outcome was SBT success rate (non-inferior margin of 10%). Extubation rate within 48 hours following successful SBT, reintubation rate within 48 hours after extubation, and hospital mortality were the exploratory outcomes.

Results:

Among 162 enrolled patients, 81 received HFOT and 81 received low-level PSV. SBT succeeded in 77/81 patients (95.1%) in each arm (absolute difference 0.0%; 95% confidence interval [CI] -7.2 to 7.2; p = 1.000). No significant differences between HFOT and low-level PSV in extubation rates following successful SBT (88.3% vs 80.5%, respectively; p = 0.183) or reintubation rates within 48 hours after extubation (8.8% vs 17.7%, respectively; p = 0.140). Hospital mortality was lower with HFOT than with low-level PSV (11.1% vs 24.7%, respectively; difference -13.6%; 95% CI -25.2 to -2.0; p = 0.024).

Conclusion:

Among mechanically ventilated patients meeting weaning criteria, HFOT demonstrated non-inferiority to low-level PSV for SBT success rates. Extubation and 48-hour reintubation rates were similar.

Clinical Trial Registration:

Thai Clinical Trials Registry; registration number: TCTR20190703002; URL: www.thaiclinicaltrials.org.

Keywords:

High-flow oxygen therapy pressure support ventilation spontaneous breathing trials weaning

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