Intensive Care Medicine

, Volume 43, Issue 11, pp 1626–1636 | Cite as

Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER)

  • Frédéric Vargas
  • Marc Clavel
  • Pascale Sanchez-Verlan
  • Sylvain Garnier
  • Alexandre Boyer
  • Hoang-Nam Bui
  • Benjamin Clouzeau
  • Charline Sazio
  • Aissa Kerchache
  • Olivier Guisset
  • Antoine Benard
  • Julien Asselineau
  • Bernard Gauche
  • Didier Gruson
  • Stein Silva
  • Philippe Vignon
  • Gilles Hilbert
Original

Abstract

Purpose

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.

Methods

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).

Results

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].

Conclusions

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.

Keywords

Noninvasive ventilation Extubation failure Weaning Chronic respiratory disorder 

Supplementary material

134_2017_4785_MOESM1_ESM.docx (160 kb)
Supplementary material 1 (DOCX 159 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Frédéric Vargas
    • 1
    • 2
  • Marc Clavel
    • 3
  • Pascale Sanchez-Verlan
    • 4
  • Sylvain Garnier
    • 5
  • Alexandre Boyer
    • 1
  • Hoang-Nam Bui
    • 1
  • Benjamin Clouzeau
    • 1
  • Charline Sazio
    • 1
  • Aissa Kerchache
    • 6
  • Olivier Guisset
    • 7
  • Antoine Benard
    • 8
  • Julien Asselineau
    • 8
  • Bernard Gauche
    • 9
  • Didier Gruson
    • 1
  • Stein Silva
    • 4
    • 10
  • Philippe Vignon
    • 3
  • Gilles Hilbert
    • 1
    • 2
  1. 1.Service de Réanimation MédicaleHôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de BordeauxBordeauxFrance
  2. 2.Centre de Recherche Cardio-ThoraciqueINSERM 1045, CIC 0005, Université de BordeauxBordeauxFrance
  3. 3.Service de Réanimation PolyvalenteCHU de Limoges, Hôpital DupuytrenLimogesFrance
  4. 4.Service de Réanimation PolyvalenteCHU de Toulouse, Hôpital PurpanToulouseFrance
  5. 5.Service de Réanimation PolyvalenteCentre Hospitalier d’AlbiAlbiFrance
  6. 6.Service de Réanimation PolyvalenteCentre Hospitalier d’AgenAgenFrance
  7. 7.Service de Réanimation MédicaleCHU de Bordeaux, Hôpital Saint-AndréBordeauxFrance
  8. 8.Service d’Information MédicaleCHU de Bordeaux, Pôle de Santé Publique, USMRBordeauxFrance
  9. 9.Service de Réanimation PolyvalenteCentre Hospitalier de LibourneLibourneFrance
  10. 10.INSERM, URM 1214, Université de ToulouseToulouseFrance

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