Annals of Intensive Care (Feb 2021)

Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial

  • Arnaud W. Thille,
  • 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, for the REVA Research Network

DOI
https://doi.org/10.1186/s13613-021-00823-7
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation. Results Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone. The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, − 14% (95% CI − 27% to − 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference − 4% (95% CI − 14% to 5%); p = 0.40]. Conclusions In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017)

Keywords