High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial.
Extubation
Extubation failure
High flow nasal cannula
Non-invasive mechanical ventilation
Reintubation
Sepsis
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
14 Sep 2021
14 Sep 2021
Historique:
received:
31
05
2021
accepted:
22
08
2021
entrez:
15
9
2021
pubmed:
16
9
2021
medline:
16
9
2021
Statut:
epublish
Résumé
High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50-77] vs. 65.5 [54-77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3-8] days in the HFNC group vs. 5 [3-9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70-1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57-1.37); P = 0.59). Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3.
Sections du résumé
BACKGROUND
BACKGROUND
High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients.
METHODS
METHODS
We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation.
RESULTS
RESULTS
Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50-77] vs. 65.5 [54-77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3-8] days in the HFNC group vs. 5 [3-9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70-1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57-1.37); P = 0.59).
CONCLUSIONS
CONCLUSIONS
Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3.
Identifiants
pubmed: 34523035
doi: 10.1186/s13613-021-00922-5
pii: 10.1186/s13613-021-00922-5
pmc: PMC8439370
doi:
Banques de données
ClinicalTrials.gov
['NCT03246893']
Types de publication
Journal Article
Langues
eng
Pagination
135Subventions
Organisme : Siriraj Critical Care Research Funding
ID : SiCCR 003
Informations de copyright
© 2021. The Author(s).
Références
Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):459-65
pubmed: 9279224
JAMA. 2016 Oct 18;316(15):1565-1574
pubmed: 27706464
Curr Opin Crit Care. 2003 Feb;9(1):59-66
pubmed: 12548031
Korean J Intern Med. 2016 Jan;31(1):82-8
pubmed: 26767861
JAMA. 2015 Jun 16;313(23):2331-9
pubmed: 25980660
Am J Respir Crit Care Med. 2003 Jul 15;168(2):165-72
pubmed: 12851245
Chest. 1997 Jul;112(1):186-92
pubmed: 9228375
Anaesth Intensive Care. 2008 May;36(3):385-90
pubmed: 18564800
J Crit Care. 2017 Apr;38:177-181
pubmed: 27927604
Eur Respir J. 2017 Aug 31;50(2):
pubmed: 28860265
Crit Care Med. 2010 Feb;38(2):491-6
pubmed: 19789441
Crit Care Med. 2011 Dec;39(12):2612-8
pubmed: 21765357
Crit Care Med. 2001 Jul;29(7):1303-10
pubmed: 11445675
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Crit Care Med. 2005 Nov;33(11):2465-70
pubmed: 16276167
J Med Assoc Thai. 2014 Jan;97 Suppl 1:S69-76
pubmed: 24855845
JAMA. 2019 Oct 15;322(15):1465-1475
pubmed: 31577036
Am J Respir Crit Care Med. 2011 Sep 15;184(6):672-9
pubmed: 21680944
Am J Respir Crit Care Med. 2006 Jan 15;173(2):164-70
pubmed: 16224108
Respir Care. 2012 Oct;57(10):1555-63
pubmed: 22324979
J Crit Care. 2015 Dec;30(6):1174-8
pubmed: 26410680
Crit Care Resusc. 2006 Dec;8(4):328-33
pubmed: 17227270
Lancet. 2009 Sep 26;374(9695):1082-8
pubmed: 19682735
Am J Trop Med Hyg. 2021 Jan;104(1):395-402
pubmed: 33146115
JAMA. 2016 Apr 5;315(13):1354-61
pubmed: 26975498
Am J Respir Crit Care Med. 1995 Jul;152(1):137-41
pubmed: 7599812
Intensive Care Med. 2020 Jul;46(7):1371-1381
pubmed: 32377766
Intensive Care Med. 2017 Jun;43(6):816-828
pubmed: 28364303