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Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial

Vaschetto, Rosanna ; Longhini, Federico ; Persona, Paolo ; Ori, Carlo ; Stefani, Giulia ; Liu, Songqiao ; Yi, Yang ; Lu, Weihua ; Yu, Tao ; Luo, Xiaoming ; Tang, Rui ; Li, Maoqin ; Li, Jiaqiong ; Cammarota, Gianmaria ; Bruni, Andrea ; Garofalo, Eugenio ; Jin, Zhaochen ; Yan, Jun ; Zheng, Ruiqiang ; Yin, Jingjing ; Guido, Stefania ; Della Corte, Francesco ; Fontana, Tiziano ; Gregoretti, Cesare ; Cortegiani, Andrea ; Giarratano, Antonino ; Montagnini, Claudia ; Cavuto, Silvio ; Qiu, Haibo ; Navalesi, Paolo

Intensive care medicine, 2019-01, Vol.45 (1), p.62-71 [Periódico revisado por pares]

Berlin/Heidelberg: Springer Berlin Heidelberg

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Título:
Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial
Autor: Vaschetto, Rosanna ; Longhini, Federico ; Persona, Paolo ; Ori, Carlo ; Stefani, Giulia ; Liu, Songqiao ; Yi, Yang ; Lu, Weihua ; Yu, Tao ; Luo, Xiaoming ; Tang, Rui ; Li, Maoqin ; Li, Jiaqiong ; Cammarota, Gianmaria ; Bruni, Andrea ; Garofalo, Eugenio ; Jin, Zhaochen ; Yan, Jun ; Zheng, Ruiqiang ; Yin, Jingjing ; Guido, Stefania ; Della Corte, Francesco ; Fontana, Tiziano ; Gregoretti, Cesare ; Cortegiani, Andrea ; Giarratano, Antonino ; Montagnini, Claudia ; Cavuto, Silvio ; Qiu, Haibo ; Navalesi, Paolo
Assuntos: Aged ; Airway Extubation - methods ; Airway Extubation - standards ; Airway Extubation - statistics & numerical data ; Anesthesiology ; Blood Gas Analysis - methods ; Chi-Square Distribution ; Clinical trials ; Critical Care Medicine ; Embolism ; Emergency Medicine ; Evidence-based medicine ; Extubation ; Female ; Hemorrhage ; Hospital patients ; Humans ; Hypoxia - therapy ; Intensive ; Intensive care ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Italy ; Length of Stay - statistics & numerical data ; Lung diseases ; Male ; Mechanical ventilation ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Mortality ; Noninvasive Ventilation - methods ; Noninvasive Ventilation - standards ; Noninvasive Ventilation - statistics & numerical data ; Original ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Pneumothorax ; Respiration, Artificial - methods ; Respiration, Artificial - statistics & numerical data ; Respiratory failure ; Respiratory therapy ; Sedatives ; Time Factors ; Tracheobronchitis ; Value-added tax ; Ventilation ; Ventilator Weaning - methods ; Ventilator-associated pneumonia ; Ventilators
É parte de: Intensive care medicine, 2019-01, Vol.45 (1), p.62-71
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Descrição: Purpose Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. Results We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0–7.0) vs. 5.5 (4.0–9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0–12.0) vs. 9.0 (6.5–12.5) days, respectively ( p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13–32) vs. 27(18–39) days ( p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. Conclusions In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.
Editor: Berlin/Heidelberg: Springer Berlin Heidelberg
Idioma: Inglês

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Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial

Berlin/Heidelberg: Springer Berlin Heidelberg

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