Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial.

Autor: Rouby JJ; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France. jjrouby@invivo.edu., Perbet S; Adult Intensive Care Unit, Department of Peri-Operative Medicine, University Hospital Estaing, University of Auvergne, Clermont-Ferrand, France., Quenot JP; Médecine Intensive Réanimation, University Hospital Centre Dijon, University of Bourgogne-Franche Comté, Dijon, France., Zhang M; Department of Emergency Medicine, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, Zhejiang, China., Andreu P; Médecine Intensive Réanimation, University Hospital Centre Dijon, University of Bourgogne-Franche Comté, Dijon, France., Assefi M; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France., Gao Y; Department of Emergency Medicine, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, Zhejiang, China., Deransy R; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France., Lyu J; Critical Care Medicine Department, Peking University People's Hospital, Beijing, China., Arbelot C; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France., An Y; Critical Care Medicine Department, Peking University People's Hospital, Beijing, China., Monsel A; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France., Jing X; Emergency Department and Emergency/Medical Intensive Care Unit, 1st Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China., Guerci P; Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Cœur et des Vaisseaux, University Hospital of Nancy, University of Lorraine, Nancy, France., Qian C; Emergency Department and Emergency/Medical Intensive Care Unit, 1st Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China., Malbouisson L; Anesthesiology, Surgical Sciences and Perioperative Medicine, University of São Paulo Hospital das Clinicas, São Paulo, Brazil., Morand D; Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France., Puybasset L; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France., Futier E; Adult Intensive Care Unit, Department of Peri-Operative Medicine, University Hospital Estaing, University of Auvergne, Clermont-Ferrand, France., Constantin JM; Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France.; Adult Intensive Care Unit, Department of Peri-Operative Medicine, University Hospital Estaing, University of Auvergne, Clermont-Ferrand, France., Pereira B; Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Nov 26; Vol. 28 (1), pp. 391. Date of Electronic Publication: 2024 Nov 26.
DOI: 10.1186/s13054-024-05166-w
Abstrakt: Background: Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF.
Methods: Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS) ≥ 14 assessed during the spontaneous breathing trial, were included in a French-Chinese randomised controlled trial. PRF was defined by 2 among the following signs: SpO 2  < 90%; Respiratory rate > 30 /min; hypercapnia; haemodynamic and/or neurological disturbances of respiratory origin. In the intervention group, prophylactic NIV alternating with HFNO was administered for 48 h following extubation. In the control group, conventional oxygen was used. Clinicians were informed on the LUS in the intervention group, those in the control group remained blind. The primary outcome was the incidence of PRF 48 h after extubation. Secondary outcomes were incidence of PRF and reintubation at day 7, number of ventilator-free days at day 28, length of ICU stay and mortality at day 28 and 90.
Results: Two hundred and forty patients were randomised and 227 analysed (intervention group = 128 and control group = 99). PRF at H48 was reduced in the intervention group compared to the control group: relative risk 0.52 (0.31 to 0.88), p = 0.01. The benefit persisted at day 7: relative risk 0.62 (0.44 to 0.96), p = 0.02. Weaning failure imposing reconnection to mechanical ventilation was not reduced. In patients who developed PRF and were treated by rescue NIV, reintubation was avoided in 44% of control patients and in 12% of intervention patients (p = 0.008). Other secondary outcomes were not different between groups. From a resource utilisation standpoint, prophylactic NIV alternating with HFNO was more demanding and costly than conventional oxygen with rescue NIV to achieve same clinical outcome.
Conclusions: Compared to conventional oxygenation, prophylactic NIV alternating with HFNO significantly reduced postextubation respiratory failure but failed to reduce reintubation rate and mortality in patients without COPD at high risk of extubation failure. Prophylactic NIV alternating with HFNO was as efficient as recue NIV to treat postextubation respiratory failure.
Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee Sud-Est VI of Clermont-Ferrand, France and by the local Ethics Committee of each Chinese centre. The WIN-IN-WEAN study was registered at ClinicalTrials.gov with identifier number 1 NCT02123940. Consent for publication: Not applicable. Competing interests: J-M. Constantin reports personal fees and non-financial support from Drager, GE Healthcare, Sedana Medical, Baxter, and Amomed; personal fees from Fisher and Paykel Healthcare, Orion, Philips Medical, and Fresenius Medical Care; and non-financial support from LFB and Bird Corporation, outside of the submitted work. All other authors declare that they have no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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