Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial.
Airway extubation
Chronic obstructive pulmonary disease
High-flow nasal oxygen
Non-invasive ventilation
Weaning
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
09 Feb 2021
09 Feb 2021
Historique:
received:
28
12
2020
accepted:
01
02
2021
entrez:
9
2
2021
pubmed:
10
2
2021
medline:
10
2
2021
Statut:
epublish
Résumé
Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation. Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone. The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, - 14% (95% CI - 27% to - 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference - 4% (95% CI - 14% to 5%); p = 0.40]. In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017).
Sections du résumé
BACKGROUND
BACKGROUND
Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation.
RESULTS
RESULTS
Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone. The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, - 14% (95% CI - 27% to - 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference - 4% (95% CI - 14% to 5%); p = 0.40].
CONCLUSIONS
CONCLUSIONS
In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017).
Identifiants
pubmed: 33559765
doi: 10.1186/s13613-021-00823-7
pii: 10.1186/s13613-021-00823-7
pmc: PMC7871306
doi:
Banques de données
ClinicalTrials.gov
['NCT03121482']
Types de publication
Journal Article
Langues
eng
Pagination
30Subventions
Organisme : Direction de l'hospitalisation et de l'offre de Soins
ID : grant number 15-0060
Investigateurs
Florence Boissier
(F)
Maeva Rodriguez
(M)
Faustine Reynaud
(F)
Delphine Chatellier
(D)
Céline Deletage
(C)
Carole Guignon
(C)
Florent Joly
(F)
Anne Veinstein
(A)
Dalila Benzekri-Lefevre
(D)
Thierry Boulain
(T)
Grégoire Muller
(G)
Yves Le Tulzo
(Y)
Jean-Marc Tadié
(JM)
Adel Maamar
(A)
Suela Demiri
(S)
Julien Mayaux
(J)
Alexandre Demoule
(A)
Lila Bouadma
(L)
Claire Dupuis
(C)
Pierre Asfar
(P)
Marc Pierrot
(M)
Gaëtan Béduneau
(G)
Déborah Boyer
(D)
Benjamin Delmas
(B)
Bérénice Puech
(B)
Konstantinos Bachoumas
(K)
Edouard Soum
(E)
Séverin Cabasson
(S)
Marie-Anne Hoppe
(MA)
Saad Nseir
(S)
Olivier Pouly
(O)
Gaël Bourdin
(G)
Sylvène Rosselli
(S)
Anthony Le Meur
(A)
Charlotte Garret
(C)
Maelle Martin
(M)
Guillaume Berquier
(G)
Abirami Thiagarajah
(A)
Guillaume Carteaux
(G)
Armand Mekontso-Dessap
(A)
Antoine Poidevin
(A)
Anne-Florence Dureau
(AF)
Marie-Ange Azais
(MA)
Gwenhaël Colin
(G)
Emmanuelle Mercier
(E)
Marlène Morisseau
(M)
Caroline Sabatier
(C)
Walter Picard
(W)
Marc Gainnier
(M)
Thi-My-Hue Nguyen
(TM)
Gwenaël Prat
(G)
Carole Schwebel
(C)
Matthieu Buscot
(M)
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