Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial
Arnaud W. Thille,
Grégoire Monseau,
Rémi Coudroy,
Mai-Anh Nay,
Arnaud Gacouin,
Maxens Decavèle,
Romain Sonneville,
François Beloncle,
Christophe Girault,
Laurence Dangers,
Alexandre Lautrette,
Quentin Levrat,
Anahita Rouzé,
Emmanuel Vivier,
Jean-Baptiste Lascarrou,
Jean-Damien Ricard,
Keyvan Razazi,
Guillaume Barberet,
Christine Lebert,
Stephan Ehrmann,
Alexandre Massri,
Jeremy Bourenne,
Gael Pradel,
Pierre Bailly,
Nicolas Terzi,
Jean Dellamonica,
Guillaume Lacave,
René Robert,
Stéphanie Ragot,
Jean-Pierre Frat,
for the HIGH-WEAN Study Group and the REVA research network
Affiliations
Arnaud W. Thille
Centre Hospitalier Universitaire de Poitiers, Service de Médecine Intensive Réanimation, Médecine Intensive Réanimation
Grégoire Monseau
Centre Hospitalier Universitaire de Poitiers, Service de Médecine Intensive Réanimation, Médecine Intensive Réanimation
Rémi Coudroy
Centre Hospitalier Universitaire de Poitiers, Service de Médecine Intensive Réanimation, Médecine Intensive Réanimation
Mai-Anh Nay
Centre Hospitalier Régional d’Orléans, Médecine Intensive Réanimation
Arnaud Gacouin
Centre Hospitalier Universitaire de Rennes, Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Ponchaillou
Maxens Decavèle
Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP 6 - Sorbonne, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université
Romain Sonneville
Hôpital Bichat - Claude Bernard, Médecine Intensive Réanimation, AP-HP, Université Paris Diderot
François Beloncle
Centre Hospitalier Universitaire d’Angers, Département de Médecine Intensive Réanimation, Université d’Angers
Christophe Girault
Centre Hospitalier Universitaire de Rouen, Hôpital Charles Nicolle, Département de Réanimation Médicale, Normandie Université, UNIROUEN, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB)
Laurence Dangers
Centre Hospitalier Universitaire Félix Guyon, Service de Réanimation Polyvalente
Alexandre Lautrette
Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied
Quentin Levrat
Centre Hospitalier de la Rochelle
Anahita Rouzé
Centre de Réanimation, Centre Hospitalier Universitaire de Lille, Université de Lille
Emmanuel Vivier
Hôpital Saint-Joseph Saint-Luc
Jean-Baptiste Lascarrou
Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes
Jean-Damien Ricard
Hôpital Louis Mourier, Réanimation Médico-Chirurgicale, AP-HP, INSERM, UMR IAME 1137, Sorbonne Paris Cité, Université Paris Diderot
Keyvan Razazi
Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale DHU A-TVB, AP-HP
Guillaume Barberet
Groupe Hospitalier Régional Mulhouse Sud Alsace, Service de Réanimation Médicale
Christine Lebert
Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée
Stephan Ehrmann
Centre Hospitalier Régional Universitaire de Tours, Médecine Intensive Réanimation, CIC 1415, Réseau CRICS-Trigger SEP, Centre d’étude des pathologies respiratoires, INSERM U1100, Université de Tours
Alexandre Massri
Centre Hospitalier de Pau, Service de Réanimation
Jeremy Bourenne
Centre Hospitalier Universitaire La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université
Gael Pradel
Service de Réanimation, Centre Hospitalier Henri Mondor d’Aurillac
Pierre Bailly
Centre Hospitalier Universitaire de Brest, Médecine Intensive Réanimation
Abstract Background In intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone. Methods Post-hoc analysis of a multicenter, randomized, controlled trial focusing on patients who experienced post-extubation respiratory failure within the 7 days following extubation. Patients were classified in the NIV group or the high-flow nasal oxygen group according to oxygenation strategy used after the onset of post-extubation respiratory failure. Patients reintubated within the first hour after extubation and those promptly reintubated without prior treatment were excluded. The primary outcome was mortality at day 28 after the onset of post-extubation respiratory failure. Results Among 651 extubated patients, 158 (25%) experienced respiratory failure and 146 were included in the analysis. Mortality at day 28 was 18% (15/84) using NIV alternating with high-flow nasal oxygen and 29% (18/62) with high flow nasal oxygen alone (difference, − 11% [95% CI, − 25 to 2]; p = 0.12). Among the 46 patients with hypercapnia at the onset of respiratory failure, mortality at day 28 was 3% (1/33) with NIV and 31% (4/13) with high-flow nasal oxygen alone (difference, − 28% [95% CI, − 54 to − 6]; p = 0.006). The proportion of patients reintubated 48 h after the onset of post-extubation respiratory failure was 44% (37/84) with NIV and 52% (32/62) with high-flow nasal oxygen alone (p = 0.21). Conclusions In patients with post-extubation respiratory failure, NIV alternating with high-flow nasal oxygen might not increase the risk of death. Trial registration number The trial was registered at http://www.clinicaltrials.gov with the registration number NCT03121482 the 20th April 2017.
