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

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalIntensive Care Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

  • Acute respiratory failure
  • Extubation
  • Hypoxemia
  • Noninvasive ventilation
  • Weaning

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial'. Together they form a unique fingerprint.

  • Cite this

    Vaschetto, R., Longhini, F., Persona, P., Ori, C., Stefani, G., Liu, S., Yi, Y., Lu, W., Yu, T., Luo, X., Tang, R., Li, M., Li, J., Cammarota, G., Bruni, A., Garofalo, E., Jin, Z., Yan, J., Zheng, R., ... Navalesi, P. (Accepted/In press). Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Medicine. https://doi.org/10.1007/s00134-018-5478-0