1. Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial
- Author
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Thille, Arnaud, Monseau, Grégoire, Coudroy, Rémi, Nay, Mai-Anh, Gacouin, Arnaud, Decavèle, Maxens, Sonneville, Romain, Beloncle, François, Girault, Christophe, Dangers, Laurence, Lautrette, Alexandre, Levrat, Quentin, Rouzé, Anahita, Vivier, Emmanuel, Lascarrou, Jean-Baptiste, Ricard, Jean-Damien, Razazi, Keyvan, Barberet, Guillaume, Lebert, Christine, Ehrmann, Stephan, Massri, Alexandre, Bourenne, Jeremy, Pradel, Gael, Bailly, Pierre, Terzi, Nicolas, Dellamonica, Jean, Lacave, Guillaume, Robert, René, Ragot, Stéphanie, Frat, Jean-Pierre, Boissier, Florence, Chatellier, Delphine, Deletage, Céline, Guignon, Carole, Joly, Florent, Olivry, Morgane, Veinstein, Anne, Benzekri-Lefevre, Dalila, Boulain, Thierry, Muller, Grégoire, Le Tulzo, Yves, Tadié, Jean-Marc, Maamar, Adel, Demiri, Suela, Mayaux, Julien, Demoule, Alexandre, Bouadma, Lila, Dupuis, Claire, Asfar, Pierre, Pierrot, Marc, Béduneau, Gaëtan, Boyer, Déborah, Delmas, Benjamin, Puech, Bérénice, Bachoumas, Konstantinos, Soum, Edouard, Cabasson, Séverin, Hoppe, Marie-Anne, Nseir, Saad, Pouly, Olivier, Bourdin, Gaël, Rosselli, Sylvène, Le Meur, Anthony, Garret, Charlotte, Martin, Maelle, Berquier, Guillaume, Thiagarajah, Abirami, Carteaux, Guillaume, Mekontso-Dessap, Armand, Poidevin, Antoine, Dureau, Anne-Florence, Azais, Marie-Ange, Colin, Gwenhaël, Mercier, Emmanuelle, Morisseau, Marlène, Sabatier, Caroline, Picard, Walter, Gainnier, Marc, Nguyen, Thi-My-Hue, Prat, Gwenaël, Schwebel, Carole, Buscot, Matthieu, Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
Male ,chemistry.chemical_element ,Airway Extubation ,Kaplan-Meier Estimate ,Critical Care and Intensive Care Medicine ,Acute respiratory failure ,Oxygen ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Ventilator weaning ,Intensive care ,Post-hoc analysis ,Medicine ,Humans ,Aged ,Aged, 80 and over ,Noninvasive Ventilation ,RC86-88.9 ,business.industry ,Research ,Airway extubation ,Oxygen Inhalation Therapy ,Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Oxygenation ,Length of Stay ,Middle Aged ,High-flow nasal oxygen ,3. Good health ,Intensive Care Units ,030228 respiratory system ,Respiratory failure ,chemistry ,Anesthesia ,Female ,medicine.symptom ,business ,Respiratory Insufficiency ,Hypercapnia - 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.
- Published
- 2021
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