Effect of Sequential Noninvasive Ventilation on Early Extubation After Acute Type A Aortic Dissection.
acute aortic dissection
extubation
noninvasive ventilation
Journal
Respiratory care
ISSN: 1943-3654
Titre abrégé: Respir Care
Pays: United States
ID NLM: 7510357
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
entrez:
27
7
2020
pubmed:
28
7
2020
medline:
26
2
2021
Statut:
ppublish
Résumé
Acute type A aortic dissection (aTAAD) is associated with a high incidence of prolonged postoperative invasive mechanical ventilation. We aimed to assess whether sequential noninvasive ventilation (NIV) could facilitate early extubation postoperatively after a spontaneous breathing trial (SBT) failure among aTAAD patients. Beginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extubation concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The primary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation. During the study period, 78 subjects with aTAAD failed their first postoperative SBT (38 subjects in phase 1 and 40 subjects in phase 2). Subjects extubated with sequential NIV had shorter median (interquartile range [IQR]) duration of invasive ventilation of 39.5 (30.8-57.8) h vs 89.5 (64-112) h ( Early extubation followed by sequential NIV significantly reduced duration of invasive ventilation and length of ICU stay without increasing re-intubation rate in postoperative subjects with aTAAD who failed their first SBT.
Sections du résumé
BACKGROUND
BACKGROUND
Acute type A aortic dissection (aTAAD) is associated with a high incidence of prolonged postoperative invasive mechanical ventilation. We aimed to assess whether sequential noninvasive ventilation (NIV) could facilitate early extubation postoperatively after a spontaneous breathing trial (SBT) failure among aTAAD patients.
METHODS
METHODS
Beginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extubation concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The primary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation.
RESULTS
RESULTS
During the study period, 78 subjects with aTAAD failed their first postoperative SBT (38 subjects in phase 1 and 40 subjects in phase 2). Subjects extubated with sequential NIV had shorter median (interquartile range [IQR]) duration of invasive ventilation of 39.5 (30.8-57.8) h vs 89.5 (64-112) h (
CONCLUSIONS
CONCLUSIONS
Early extubation followed by sequential NIV significantly reduced duration of invasive ventilation and length of ICU stay without increasing re-intubation rate in postoperative subjects with aTAAD who failed their first SBT.
Identifiants
pubmed: 32712583
pii: 65/8/1160
doi: 10.4187/respcare.07522
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1160-1167Informations de copyright
Copyright © 2020 by Daedalus Enterprises.
Déclaration de conflit d'intérêts
This work was supported in part by grants from the Research Funds of Zhongshan Hospital (2019ZSYXQN34, 2019ZSQN13, 2018ZSQN53, and XYYX201922) and the Research Fund of Shanghai Municipal Health Commission (2019ZB0105). The authors have disclosed no conflicts of interest.