Title |
Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER)
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Published in |
Intensive Care Medicine, April 2017
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DOI | 10.1007/s00134-017-4785-1 |
Pubmed ID | |
Authors |
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 |
Abstract |
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. 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). 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]. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Spain | 13 | 16% |
United States | 7 | 9% |
United Kingdom | 7 | 9% |
Colombia | 7 | 9% |
France | 3 | 4% |
Brazil | 3 | 4% |
Saudi Arabia | 2 | 3% |
Argentina | 2 | 3% |
Australia | 2 | 3% |
Other | 9 | 11% |
Unknown | 24 | 30% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 55 | 70% |
Practitioners (doctors, other healthcare professionals) | 15 | 19% |
Scientists | 5 | 6% |
Science communicators (journalists, bloggers, editors) | 4 | 5% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Colombia | 1 | <1% |
Unknown | 114 | 99% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 15 | 13% |
Researcher | 14 | 12% |
Student > Master | 14 | 12% |
Student > Postgraduate | 10 | 9% |
Student > Bachelor | 9 | 8% |
Other | 21 | 18% |
Unknown | 32 | 28% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 51 | 44% |
Nursing and Health Professions | 16 | 14% |
Computer Science | 2 | 2% |
Engineering | 2 | 2% |
Neuroscience | 2 | 2% |
Other | 3 | 3% |
Unknown | 39 | 34% |