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 - 08/01/26
, Rémi Coudroy 1, 2 , Mai-Anh Nay 3 , Arnaud Gacouin 4 , Maxens Decavèle 5 , Romain Sonneville 6 , François Beloncle 7 , Christophe Girault 8 , Laurence Dangers 9 , Alexandre Lautrette 10 , Quentin Levrat 11 , Anahita Rouzé 12 , Emmanuel Vivier 13 , Jean-Baptiste Lascarrou 14 , Jean-Damien Ricard 15 , Keyvan Razazi 16 , Guillaume Barberet 17 , Christine Lebert 18 , Stephan Ehrmann 19 , Alexandre Massri 20 , Jeremy Bourenne 21 , Gael Pradel 22 , Pierre Bailly 23 , Nicolas Terzi 24 , Jean Dellamonica 25 , Guillaume Lacave 26 , René Robert 1, 2 , Stéphanie Ragot 2 , Jean-Pierre Frat 1, 2 for the HIGH-WEAN Study Group, for the REVA Research Network
Florence Boissier, Maeva Rodriguez, Faustine Reynaud, Delphine Chatellier, Céline Deletage, Carole Guignon, Florent Joly, Anne Veinstein, Dalila Benzekri-Lefevre, Thierry Boulain, Grégoire Muller, Yves Le Tulzo, Jean-Marc Tadié, Adel Maamar, Suela Demiri, Julien Mayaux, Alexandre Demoule, Lila Bouadma, Claire Dupuis, Pierre Asfar, Marc Pierrot, Gaëtan Béduneau, Déborah Boyer, Benjamin Delmas, Bérénice Puech, Konstantinos Bachoumas, Edouard Soum, Séverin Cabasson, Marie-Anne Hoppe, Saad Nseir, Olivier Pouly, Gaël Bourdin, Sylvène Rosselli, Anthony Le Meur, Charlotte Garret, Maelle Martin, Guillaume Berquier, Abirami Thiagarajah, Guillaume Carteaux, Armand Mekontso-Dessap, Antoine Poidevin, Anne-Florence Dureau, Marie-Ange Azais, Gwenhaël Colin, Emmanuelle Mercier, Marlène Morisseau, Caroline Sabatier, Walter Picard, Marc Gainnier, Thi-My-Hue Nguyen, Gwenaël Prat, Carole Schwebel, Matthieu Buscot
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Abstract |
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 |
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 |
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 www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017)
Le texte complet de cet article est disponible en PDF.Keywords : Airway extubation, Weaning, Non-invasive ventilation, High-flow nasal oxygen, Chronic obstructive pulmonary disease
Keywords : Medical and Health Sciences, Cardiorespiratory Medicine and Haematology
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Vol 11 - N° 1
Article 30- 2021 Retour au numéro
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