Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study

INTRODUCTION@#Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC.@*METHODS@#We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC.@*RESULTS@#Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, @*CONCLUSION@#Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.

Resveratrol and pterostilbene: A comparative overview of their chemistry, biosynthesis, plant sources and pharmacological properties

Both resveratrol and pterostilbene are monomeric stilbenes having a 6−2−6 carbon skeleton with two phenyl ringslinked by a double-bonded ethylene bridge. Resveratrol has three hydroxyl (−OH) groups, while pterostilbene hastwo methoxy (–OCH3) groups and one −OH group. They commonly occur in the trans form rather than the cis form.Red grapes and red wines are the main dietary sources of the resveratrol. Pterostilbene occurs in blueberries andgrapes. Resveratrol and pterostilbene exhibit many similarities in pharmacological properties, including antioxidant,neuroprotective anti-cancer, cardioprotective, analgesic, anti-atherosclerosis, anti-aging, anti-diabetic, antiinflammatory, and anti-obesity activities. The stronger pharmacological properties in pterostilbene than resveratrolhave been attributed to its two –OCH3 groups. As a result, pterostilbene is more lipophilic which enhances itsmembrane permeability, bioavailability, and biological potency. Some future studies on resveratrol and pterostilbeneare suggested. The sources of information cited in this comparative overview were from Science Direct, GoogleScholar, and PubMed.