Protocolized Postextubation Respiratory Support to Prevent Reintubation: A Randomized Clinical Trial
| Autor: | E. Wesley Ely, Matthew W. Semler, Eric J Hall, Karen E. Jackson, Christopher J. Lindsell, Roger K Richardson, Todd W. Rice, Jonathan D Casey, Gordon R. Bernard, Alexandra H Toporek, Reagan B Buie, Wesley H. Self, B.D. Lloyd, Kevin G Buell, Li Wang, Erin M Vaughan, Peter A Billas, Ryan M Brown, J Craig Rooks |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_treatment Critical Care and Intensive Care Medicine medicine.disease_cause Perioperative Care law.invention Hypercapnia Tracheal extubation Randomized controlled trial Clinical Protocols law medicine Intubation Intratracheal Cannula Humans Acute respiratory failure Hypoxia Aged Mechanical ventilation Cross-Over Studies Noninvasive Ventilation business.industry Oxygen Inhalation Therapy Editorials Original Articles Middle Aged Respiratory support Intensive Care Units Treatment Outcome Anesthesia Airway Extubation Consciousness Disorders Noninvasive ventilation Female business Respiratory Insufficiency Ventilator Weaning Nasal cannula |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine Am J Respir Crit Care Med |
| ISSN: | 1535-4970 |
| Popis: | Rationale: Respiratory support (noninvasive ventilation or high-flow nasal cannula) applied at the time of extubation has been reported to reduce reintubation rates, but concerns regarding effectiveness have limited uptake into practice. Objectives: To determine if providing postextubation respiratory support to all patients undergoing extubation in a medical ICU would decrease the incidence of reintubation. Methods: We conducted a pragmatic, two-armed, cluster–crossover trial of adults undergoing extubation from invasive mechanical ventilation between October 1, 2017, and March 31, 2019, in the medical ICU of an academic medical center. Patients were assigned to either protocolized postextubation respiratory support (a respiratory therapist–driven protocol in which patients with suspected hypercapnia received noninvasive ventilation and patients without suspected hypercapnia received high-flow nasal cannula) or usual care (postextubation management at the discretion of treating clinicians). The primary outcome was reintubation within 96 hours of extubation. Measurements and Main Results: A total of 751 patients were enrolled. Of the 359 patients assigned to protocolized support, 331 (92.2%) received postextubation respiratory support compared with 66 of 392 patients (16.8%) assigned to usual care, a difference driven by differential use of high-flow nasal cannula (74.7% vs. 2.8%). A total of 57 patients (15.9%) in the protocolized support group experienced reintubation compared with 52 patients (13.3%) in the usual care group (odds ratio, 1.23; 95% confidence interval, 0.82 to 1.84; P = 0.32). Conclusions: Among a broad population of critically ill adults undergoing extubation from invasive mechanical ventilation at an academic medical center, protocolized postextubation respiratory support, primarily characterized by an increase in the use of high-flow nasal cannula, did not prevent reintubation compared with usual care. Clinical trial registered with www.clinicaltrials.gov (NCT0328831). |
| Databáze: | OpenAIRE |
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