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Intensive Care Medicine

, Volume 45, Issue 1, pp 62–71 | Cite as

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 Yin
  • Stefania Guido
  • Francesco Della Corte
  • Tiziano Fontana
  • Cesare Gregoretti
  • Andrea Cortegiani
  • Antonino Giarratano
  • Claudia Montagnini
  • Silvio Cavuto
  • Haibo Qiu
  • Paolo NavalesiEmail author
Original

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.

Keywords

Noninvasive ventilation Hypoxemia Extubation Acute respiratory failure Weaning 

Notes

Compliance with ethical standards

Conflicts of interest

Dr. Gregoretti received fees for consulting or lectures from Philips, Merdtronic, Resmed, Vivisol, Orion Pharma, and Origin. Dr. Cavuto received fees from Intersurgical S.p.A. Dr. Navalesi’s research laboratory has received equipment and grants from Maquet Critical Care, Draeger, and Intersurgical S.p.A. He also received honoraria/speaking fees from Maquet Critical Care, Orionpharma, Philips, Resmed, MSD, and Novartis. Dr Navalesi contributed to the development of the Next helmet, whose license for patent belongs to Intersurgical S.P.A., and receives royalties for that invention. Drs. Vaschetto, Longhini, Persona, Ori, Stefani, Liu, Yi, Lu, Yu, Luo, Tang, Li, Li, Cammarota, Bruni, Garofalo, Jin, Yan, Zheng, Yin, Guido, Della Corte, Fontana, Cortegiani, Giarratano, Montagnini, and Qiu declare that they do not have conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Supplementary material

134_2018_5478_MOESM1_ESM.docx (32 kb)
Supplementary material 1 (DOCX 32 kb)
134_2018_5478_MOESM2_ESM.doc (43 kb)
Supplementary material 2 (DOC 43 kb)
134_2018_5478_MOESM3_ESM.doc (40 kb)
Supplementary material 3 (DOC 40 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Rosanna Vaschetto
    • 1
    • 2
  • Federico Longhini
    • 3
  • Paolo Persona
    • 4
  • Carlo Ori
    • 5
  • Giulia Stefani
    • 5
  • Songqiao Liu
    • 6
  • Yang Yi
    • 6
  • Weihua Lu
    • 7
  • Tao Yu
    • 7
  • Xiaoming Luo
    • 8
  • Rui Tang
    • 8
  • Maoqin Li
    • 9
  • Jiaqiong Li
    • 9
  • Gianmaria Cammarota
    • 1
  • Andrea Bruni
    • 10
  • Eugenio Garofalo
    • 10
  • Zhaochen Jin
    • 11
  • Jun Yan
    • 11
  • Ruiqiang Zheng
    • 12
  • Jingjing Yin
    • 12
  • Stefania Guido
    • 1
  • Francesco Della Corte
    • 1
    • 2
  • Tiziano Fontana
    • 13
  • Cesare Gregoretti
    • 14
  • Andrea Cortegiani
    • 14
  • Antonino Giarratano
    • 14
  • Claudia Montagnini
    • 1
  • Silvio Cavuto
    • 15
  • Haibo Qiu
    • 6
  • Paolo Navalesi
    • 10
    Email author
  1. 1.Azienda Ospedaliero Universitaria “Maggiore Della Carità”, Anestesia e Terapia IntensivaNovaraItaly
  2. 2.Università del Piemonte OrientaleNovaraItaly
  3. 3.Ospedale Sant’Andrea, Anestesia e RianimazioneVercelliItaly
  4. 4.Emergency DepartmentAzienda Ospedaliera di PadovaPaduaItaly
  5. 5.Department of Medicine, DIMEDUniversity of PadovaPaduaItaly
  6. 6.Department of Critical Care Medicine, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
  7. 7.Department of Critical Care MedicineThe First Affiliated Hospital of Wannan Medical CollegeWuhuChina
  8. 8.Department of Critical Care MedicineThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
  9. 9.Department of Critical Care MedicineXuzhou Central HospitalXuzhouChina
  10. 10.Anestesia e Rianimazione, Dipartimento di Scienze Mediche e ChirurgicheUniversità “Magna Graecia”CatanzaroItaly
  11. 11.Department of Critical Care MedicineZhenjiang First People’s HospitalZhenjiangChina
  12. 12.Department of Critical Care MedicineNorthern Jiangsu People’s HospitalYangzhouChina
  13. 13.Azienda Sanitaria Locale del Verbano Cusio Ossola, Anestesia e RianimazioneDomodossolaItaly
  14. 14.Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
  15. 15.Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCSS.C. Infrastruttura Ricerca e StatisticaReggio EmiliaItaly

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