Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial

Critical Care

for the HIGH-WEAN Study Group and the REVA research network¹  Stephan Ehrmann²  Mai-Anh Nay³  Laurence Dangers⁴  Nicolas Terzi⁵  Jeremy Bourenne⁶  Pierre Bailly⁷  Alexandre Lautrette⁸  Jean Dellamonica⁹  René Robert^1,10  Rémi Coudroy^1,10  Jean-Pierre Frat^1,10  Arnaud W. Thille^1,10  Grégoire Monseau^1,10  Arnaud Gacouin^1,11  Christophe Girault^1,12  François Beloncle^1,13  Alexandre Massri^1,14  Guillaume Lacave^1,15  Quentin Levrat^1,16  Anahita Rouzé^1,17  Stéphanie Ragot^1,18  Guillaume Barberet^1,19  Romain Sonneville^2,20  Jean-Damien Ricard^2,21  Maxens Decavèle^2,22  Emmanuel Vivier^2,23  Keyvan Razazi^2,24  Jean-Baptiste Lascarrou^2,25  Christine Lebert^2,26  Gael Pradel^2,27 

[1] ;Centre Hospitalier Régional Universitaire de Tours, Médecine Intensive Réanimation, CIC 1415, Réseau CRICS-Trigger SEP, Centre d’étude des pathologies respiratoires, INSERM U1100, Université de Tours;Centre Hospitalier Régional d’Orléans, Médecine Intensive Réanimation;Centre Hospitalier Universitaire Félix Guyon, Service de Réanimation Polyvalente;Centre Hospitalier Universitaire Grenoble Alpes, Médecine Intensive Réanimation, INSERMU1042, HP2, Université Grenoble-Alpes;Centre Hospitalier Universitaire La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université;Centre Hospitalier Universitaire de Brest, Médecine Intensive Réanimation;Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied;Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA, Université Cote d’Azur;Centre Hospitalier Universitaire de Poitiers, Service de Médecine Intensive Réanimation, Médecine Intensive Réanimation;Centre Hospitalier Universitaire de Rennes, Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Ponchaillou;Centre Hospitalier Universitaire de Rouen, Hôpital Charles Nicolle, Département de Réanimation Médicale, Normandie Université, UNIROUEN, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB);Centre Hospitalier Universitaire d’Angers, Département de Médecine Intensive Réanimation, Université d’Angers;Centre Hospitalier de Pau, Service de Réanimation;Centre Hospitalier de Versailles, Service de Réanimation Médico-Chirurgicale;Centre Hospitalier de la Rochelle;Centre de Réanimation, Centre Hospitalier Universitaire de Lille, Université de Lille;Centre d’Investigation Clinique 1402 ALIVE Research Group, University of Poitiers;Groupe Hospitalier Régional Mulhouse Sud Alsace, Service de Réanimation Médicale;Hôpital Bichat - Claude Bernard, Médecine Intensive Réanimation, AP-HP, Université Paris Diderot;Hôpital Louis Mourier, Réanimation Médico-Chirurgicale, AP-HP, INSERM, UMR IAME 1137, Sorbonne Paris Cité, Université Paris Diderot;Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP 6 - Sorbonne, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université;Hôpital Saint-Joseph Saint-Luc;Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale DHU A-TVB, AP-HP;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes;Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée;Service de Réanimation, Centre Hospitalier Henri Mondor d’Aurillac;

关键词: Airway extubation;    Ventilator weaning;    Acute respiratory failure;    Noninvasive ventilation;    High-flow nasal oxygen;   

DOI  :  10.1186/s13054-021-03621-6

来源: DOAJ

【 摘 要 】

Abstract Background In intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone. Methods Post-hoc analysis of a multicenter, randomized, controlled trial focusing on patients who experienced post-extubation respiratory failure within the 7 days following extubation. Patients were classified in the NIV group or the high-flow nasal oxygen group according to oxygenation strategy used after the onset of post-extubation respiratory failure. Patients reintubated within the first hour after extubation and those promptly reintubated without prior treatment were excluded. The primary outcome was mortality at day 28 after the onset of post-extubation respiratory failure. Results Among 651 extubated patients, 158 (25%) experienced respiratory failure and 146 were included in the analysis. Mortality at day 28 was 18% (15/84) using NIV alternating with high-flow nasal oxygen and 29% (18/62) with high flow nasal oxygen alone (difference, − 11% [95% CI, − 25 to 2]; p = 0.12). Among the 46 patients with hypercapnia at the onset of respiratory failure, mortality at day 28 was 3% (1/33) with NIV and 31% (4/13) with high-flow nasal oxygen alone (difference, − 28% [95% CI, − 54 to − 6]; p = 0.006). The proportion of patients reintubated 48 h after the onset of post-extubation respiratory failure was 44% (37/84) with NIV and 52% (32/62) with high-flow nasal oxygen alone (p = 0.21). Conclusions In patients with post-extubation respiratory failure, NIV alternating with high-flow nasal oxygen might not increase the risk of death. Trial registration number The trial was registered at http://www.clinicaltrials.gov with the registration number NCT03121482 the 20th April 2017.

【 授权许可】

Unknown