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Updated: May 13, 2026

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Retrospective Propensity-Matched Comparison of Noninvasive Positive Pressure Ventilation Versus High-Flow Nasal
Jianwen Wang1,2, Yinxia Lv1, Yihua Zeng3,2
1Department of Respiratory Care, West China Hospital of Sichuan University, Chengdu, 610041, China.
Objective:
This study compared the effectiveness of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC) in preventing reintubation among neurosurgical intensive care patients following extubation.
Methods:
A retrospective cohort study was conducted on neurosurgical ICU patients who received either NIPPV or HFNC after extubation. Propensity score matching was applied to balance baseline characteristics between the two groups. The primary outcome was reintubation rate, analyzed using Kaplan-Meier survival estimates and Cox proportional hazards regression. Subgroup analyses were performed to evaluate potential effect modifiers.
Results:
Among 202 matched patients, the overall reintubation event count was 48. Kaplan-Meier analysis showed no significant difference in cumulative reintubation rate between groups (log-rank p = 0.704). Cumulative reintubation rate at 168 h was 24.8% for NIPPV and 22.8% for HFNC. Cox regression demonstrated a nonsignificant hazard ratio of 0.90 (95% CI, 0.51-1.58; p = 0.706) for HFNC compared with NIPPV. Subgroup analyses confirmed no significant effect modifications across various clinical variables. The exploratory analyses revealed that there was no significant difference in the reintubation rate between the prophylactic and the rescue NRS groups (prophylactic NRS: 25.0% vs. rescue NRS: 22.8%; p = 0.717).
Conclusions:
In a retrospective study of neurosurgical intensive care patients, HFNC and NIPPV showed similar efficacy in preventing reintubation. Moreover, prophylactic and rescue NRS were not associated with reintubation. Prospective trials are needed to confirm treatment effects in this population.
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