Skip to main content
  • Letter to the Editor
  • Open access
  • Published:

High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial

A Letter to the Editor to this article was published on 13 December 2021

The Original Article was published on 14 September 2021

Dear editor,

We read with great interest the article of Tongyoo et al. “High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial” published in Annals of Intensive Care [1]. The authors compared high-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) as a ventilatory support in post-extubated sepsis patients seeking a reduction of the reintubation rate using HFNC. A few reservations could be considered.

We felt that the study could have followed a more comprehensive approach concerning acute respiratory failure, pulmonary mechanics and physiology of ventilatory management. This is particularly perceptible in front of the absence of data characterizing patients’ neural drive and pulmonary mechanics, namely, airway pressures, airway collapsibility and respiratory system compliance and resistance [2], both prior and after extubation, which could identify a type of patients benefiting from NIV over HFNC and vice versa. Another important factor to assess, is the patient’s psychological state which could be a cause of extubation failure and thereafter alter the adherence to a type of ventilatory support.

Secondly, the causes of reintubation presented by the authors could mostly be described as consequences of severe acute respiratory failure (hypoxia, inability to clear secretion, altered mental status, cardiac arrest, etc.), whereas it would have been more adapted to characterize the direct clinical causes of the respiratory failure such as, delirium, neuromuscular disorders, laryngeal edema, airways collapsibility, left heart failure, etc.

In our opinion, adapting different means of ventilatory support in accordance to the natural evolution of a disease, or in this particular case, according to the mechanism and severity of the post-extubation acute respiratory failure is more interesting than comparing one technique of ventilatory support to another. NIV is adapted in ARF associated with altered respiratory mechanics while HFNC is adapted to situations at risk of high patient–device interaction generating P-SILI (Patient Self-Inflicted Lung Injury).

Perhaps, taking into consideration the previously stated data, identifying a subgroup of patients presenting the same mechanism of post-extubation respiratory failure that would benefit from one technique rather than the other would be feasible and of great value.

Availability of data and materials




High-flow nasal cannula


Noninvasive ventilation


Patient self-inflicted lung injury


  1. Tongyoo S, Tantibundit P, Daorattanachai K, Viarasilpa T, Permpikul C, Udompanturak S. High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial. Ann Intensive Care. 2021;11:135.

    Article  Google Scholar 

  2. Boles JM, Blon J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–56.

    Article  Google Scholar 

Download references





Author information

Authors and Affiliations



RT, KM, MB: substantial contributions to the critical appraisal of the paper, the letter conception and design, drafting the article and revising it critically for intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohamed Boussarsar.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Toumi, R., Meddeb, K. & Boussarsar, M. High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial. Ann. Intensive Care 11, 172 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: