ArticleNeurocritical care2026
Physiological Effects of High-Flow Tracheal Oxygen vs. Pressure Support Ventilation in Neurosurgical Patients with Brain Tumors Facing Delayed Extubation: A Pilot Study.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative neurosurgical patients who successfully pass a spontaneous breathing trial (SBT) may still require delayed extubation due to impaired airway protection. Continued mechanical ventilation may contribute to diaphragm underuse. High-flow tracheal oxygen (HFTO) offers an alternative-discontinuing positive pressure while maintaining airway access-but its physiological effects in intubated neurosurgical patients remain poorly characterized.
methodsIn this prospective, randomized physiological pilot study, postoperative neurosurgical patients who required delayed extubation were assigned (1:1) to HFTO or low-level pressure support ventilation (PSV). Esophageal pressure monitoring and diaphragmatic ultrasound were performed at baseline and at 2, 12, 24, and 48 h. The primary endpoint was inspiratory effort assessed by esophageal pressure-time product (PTPes) per min. Secondary outcomes included diaphragmatic function, respiratory parameters, safety, and clinical outcomes.
resultsA total of 24 patients were randomized; 1 patient was withdrawn due to intracranial rebleeding, leaving 23 patients for analysis (HFTO, n = 12; PSV, n = 11). HFTO exhibited a significantly different temporal trajectory in inspiratory effort (group-by-time interaction P = 0.019), characterized by an acute physiological step-up immediately after withdrawing positive pressure support, followed by a stable plateau from 2 to 48 h. Diaphragmatic indices remained unchanged in both groups over 48 h. Airway pressures were significantly lower in the HFTO group (all P < 0.001), accompanied by modest declines in partial pressure of arterial oxygen (PaO
conclusionsHFTO was univariately associated with increased inspiratory effort compared with low-level PSV, without short-term diaphragmatic harm or increased clinical instability in postoperative neurosurgical patients requiring delayed extubation. These findings suggest HFTO as a feasible strategy for liberation from mechanical ventilation while maintaining airway safety. Larger multicenter studies are warranted.
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