Optimizing High-flow Nasal Cannula Settings: Comparing Different Flow Approaches and Exploring Physiological Phenotyping With End-expiratory Lung Volume, Peak Tidal Inspiratory Flow and Oxygen Demand

Status: Recruiting
Location: See location...
Intervention Type: Other
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

The goal of this randomized trial is to compare four different flow-setting approaches for post-extubation use of high-flow nasal cannula (HFNC). Selecting the appropriate flow rate when initiating HFNC oxygen therapy is both crucial and challenging for clinicians, as the physiological benefits of HFNC depend significantly on the flow rate. To date, there are no guidelines or consensus on flow-rate setting and weaning for HFNC oxygen therapy. The investigators hypothesized that physiological marker-guided flow setting using peak tidal inspiratory flow (PTIF) or PaO₂/FiO₂ ratios lead to better extubation outcomes as compared to empirical flow setting of 40 L/min or 60 L/min. Participants will be randomly assigned to one of four study groups with different flow setting strategies summarized as follows: (1) Setting flow at 40 L/min, (2) Setting flow at 5 L/min above the peak tidal inspiratory flow, up to a maximum of 60 L/min. (3) Setting flow according to P/F ratio prior to extubation. Flow will be set at 60, 50 40 L/min if P/F ratio \<250 mmHg, 250-300 mmHg and \>300 mmHg, respectively. (4) Setting flow at 60 L/min.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Intubated and receiving mechanical ventilation for more than 24 hours

• Ready for planned extubation after passing a spontaneous breathing trial

• PaO2/FiO2 \<350 mmHg on the day of extubation

Locations
Other Locations
Taiwan
National Taiwan University Hospital
RECRUITING
Taipei
Contact Information
Primary
Sheng-Yuan Ruan, MD, PhD
syruan@ntu.edu.tw
886223123456
Time Frame
Start Date: 2025-06-05
Estimated Completion Date: 2028-06-30
Participants
Target number of participants: 480
Treatments
Active_comparator: Flow of 40L/min
Setting HFNC flow at 40 L/min
Experimental: Peak tidal inspiratory flow (PTIF) guided
Setting HFNC flow at 5 L/min above the peak tidal inspiratory flow (PTIF), up to a maximum of 60 L/min.
Experimental: PaO2/FiO2 ratio guided
Setting HFNC flow according to P/F ratio prior to extubation. Flow will be set at 60, 50 40 L/min if P/F ratio \<250 mmHg, 250-300 mmHg and \>300 mmHg, respectively.
Experimental: Flow of 60L/min
Setting HFNC flow at 60 L/min
Related Therapeutic Areas
Sponsors
Leads: National Taiwan University Hospital

This content was sourced from clinicaltrials.gov