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Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER).
- Source :
-
Intensive Care Medicine . Nov2017, Vol. 43 Issue 11, p1626-1636. 11p. 1 Diagram, 3 Charts, 1 Graph. - Publication Year :
- 2017
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Abstract
- <bold>Purpose: </bold>Early noninvasive ventilation (NIV) after extubation decreases the risk of respiratory failure and lowers 90-day mortality in patients with hypercapnia. Patients with chronic respiratory disease are at risk of extubation failure. Therefore, it could be useful to determine the role of NIV with a discontinuous approach, not limited to patients with hypercapnia. We assessed the efficacy of early NIV in decreasing respiratory failure after extubation in patients with chronic respiratory disorders.<bold>Methods: </bold>A prospective randomized controlled multicenter study was conducted. We enrolled 144 mechanically ventilated patients with chronic respiratory disorders who tolerated a spontaneous breathing trial. Patients were randomly allocated after extubation to receive either NIV (NIV group, n = 72), performed with a discontinuous approach, for the first 48 h, or conventional oxygen treatment (usual care group, n = 72). The primary endpoint was decreased respiratory failure within 48 h after extubation. Analysis was by intention to treat. This trial was registered with ClinicalTrials.gov (NCT01047852).<bold>Results: </bold>Respiratory failure after extubation was less frequent in the NIV group: 6 (8.5%) versus 20 (27.8%); p = 0.0016. Six patients (8.5%) in the NIV group versus 13 (18.1%) in the usual care group were reintubated; p = 0.09. Intensive care unit (ICU) mortality and 90-day mortality did not differ significantly between the two groups (p = 0.28 and p = 0.33, respectively). Median postrandomization ICU length of stay was lower in the usual care group: 3 days (IQR 2-6) versus 4 days (IQR 2-7; p = 0.008). Patients with hypercapnia during a spontaneous breathing trial were at risk of developing postextubation respiratory failure [adjusted odds ratio (95% CI) = 4.56 (1.59-14.00); p = 0.006] and being intubated [adjusted odds ratio (95% CI) = 3.60 (1.07-13.31); p = 0.04].<bold>Conclusions: </bold>Early NIV performed following a sequential protocol for the first 48 h after extubation decreased the risk of respiratory failure in patients with chronic respiratory disorders. Reintubation and mortality did not differ between NIV and conventional oxygen therapy. [ABSTRACT FROM AUTHOR]
- Subjects :
- *NONINVASIVE ventilation
*AIRWAY extubation
*HYPERCAPNIA
*OXYGEN therapy
*INTUBATION
*RANDOMIZED controlled trials
*AIRWAY (Anatomy)
*ARTIFICIAL respiration
*CHRONIC diseases
*CLINICAL trials
*COMPARATIVE studies
*LENGTH of stay in hospitals
*INTENSIVE care units
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*RESPIRATORY diseases
*RESPIRATORY insufficiency
*MECHANICAL ventilators
*EVALUATION research
*PREVENTION
*THERAPEUTICS
TREATMENT of respiratory diseases
RESPIRATORY insufficiency treatment
Subjects
Details
- Language :
- English
- ISSN :
- 03424642
- Volume :
- 43
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Intensive Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 125560135
- Full Text :
- https://doi.org/10.1007/s00134-017-4785-1