Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial

Cesare Gregoretti, Antonino Giarratano, Andrea Cortegiani, Paolo Persona, Songqiao Liu, Jiaqiong Li, Claudia Montagnini, Rosanna Vaschetto, Gianmaria Cammarota, Zhaochen Jin, Giulia Stefani, Federico Longhini, Yang Yi, Stefania Guido, Jun Yan, Weihua Lu, Eugenio Garofalo, Andrea Bruni, Xiaoming Luo, Jun YanHaibo Qiu, Francesco Della Corte, Rui Tang, Jingjing Yin, Tiziano Fontana, Tao Yu, Silvio Cavuto, Paolo Navalesi, Carlo Ori, Maoqin Li, Ruiqiang Zheng

Risultato della ricerca: Article

10 Citazioni (Scopus)

Abstract

Purpose: Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods: Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. Results: We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0–7.0) vs. 5.5 (4.0–9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0–12.0) vs. 9.0 (6.5–12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13–32) vs. 27(18–39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. Conclusions: In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.
Lingua originaleEnglish
pagine (da-a)62-71
Numero di pagine10
RivistaIntensive Care Medicine
Volume45
Stato di pubblicazionePublished - 2019

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Noninvasive Ventilation
Length of Stay
Randomized Controlled Trials
Intensive Care Units
Artificial Respiration
Ventilator-Associated Pneumonia
Hospital Mortality
Treatment Failure
Tracheotomy
Tracheostomy
Pneumothorax
Mechanical Ventilators
Hypnotics and Sedatives
Pulmonary Embolism
Respiratory Insufficiency
Nervous System
Ventilation
Therapeutics
Kidney
Control Groups

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cita questo

Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. / Gregoretti, Cesare; Giarratano, Antonino; Cortegiani, Andrea; Persona, Paolo; Liu, Songqiao; Li, Jiaqiong; Montagnini, Claudia; Vaschetto, Rosanna; Cammarota, Gianmaria; Jin, Zhaochen; Stefani, Giulia; Longhini, Federico; Yi, Yang; Guido, Stefania; Yan, Jun; Lu, Weihua; Garofalo, Eugenio; Bruni, Andrea; Luo, Xiaoming; Yan, Jun; Qiu, Haibo; Della Corte, Francesco; Tang, Rui; Yin, Jingjing; Fontana, Tiziano; Yu, Tao; Cavuto, Silvio; Navalesi, Paolo; Ori, Carlo; Li, Maoqin; Zheng, Ruiqiang.

In: Intensive Care Medicine, Vol. 45, 2019, pag. 62-71.

Risultato della ricerca: Article

Gregoretti, C, Giarratano, A, Cortegiani, A, Persona, P, Liu, S, Li, J, Montagnini, C, Vaschetto, R, Cammarota, G, Jin, Z, Stefani, G, Longhini, F, Yi, Y, Guido, S, Yan, J, Lu, W, Garofalo, E, Bruni, A, Luo, X, Yan, J, Qiu, H, Della Corte, F, Tang, R, Yin, J, Fontana, T, Yu, T, Cavuto, S, Navalesi, P, Ori, C, Li, M & Zheng, R 2019, 'Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial', Intensive Care Medicine, vol. 45, pagg. 62-71.
Gregoretti, Cesare ; Giarratano, Antonino ; Cortegiani, Andrea ; Persona, Paolo ; Liu, Songqiao ; Li, Jiaqiong ; Montagnini, Claudia ; Vaschetto, Rosanna ; Cammarota, Gianmaria ; Jin, Zhaochen ; Stefani, Giulia ; Longhini, Federico ; Yi, Yang ; Guido, Stefania ; Yan, Jun ; Lu, Weihua ; Garofalo, Eugenio ; Bruni, Andrea ; Luo, Xiaoming ; Yan, Jun ; Qiu, Haibo ; Della Corte, Francesco ; Tang, Rui ; Yin, Jingjing ; Fontana, Tiziano ; Yu, Tao ; Cavuto, Silvio ; Navalesi, Paolo ; Ori, Carlo ; Li, Maoqin ; Zheng, Ruiqiang. / Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. In: Intensive Care Medicine. 2019 ; Vol. 45. pagg. 62-71.
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title = "Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial",
abstract = "Purpose: Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods: Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. Results: We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0–7.0) vs. 5.5 (4.0–9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0–12.0) vs. 9.0 (6.5–12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9{\%} vs. 25{\%}, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57{\%} vs. 85{\%}, p = 0.001), and hospital LOS, 20 (13–32) vs. 27(18–39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. Conclusions: In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.",
author = "Cesare Gregoretti and Antonino Giarratano and Andrea Cortegiani and Paolo Persona and Songqiao Liu and Jiaqiong Li and Claudia Montagnini and Rosanna Vaschetto and Gianmaria Cammarota and Zhaochen Jin and Giulia Stefani and Federico Longhini and Yang Yi and Stefania Guido and Jun Yan and Weihua Lu and Eugenio Garofalo and Andrea Bruni and Xiaoming Luo and Jun Yan and Haibo Qiu and {Della Corte}, Francesco and Rui Tang and Jingjing Yin and Tiziano Fontana and Tao Yu and Silvio Cavuto and Paolo Navalesi and Carlo Ori and Maoqin Li and Ruiqiang Zheng",
year = "2019",
language = "English",
volume = "45",
pages = "62--71",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial

AU - Gregoretti, Cesare

AU - Giarratano, Antonino

AU - Cortegiani, Andrea

AU - Persona, Paolo

AU - Liu, Songqiao

AU - Li, Jiaqiong

AU - Montagnini, Claudia

AU - Vaschetto, Rosanna

AU - Cammarota, Gianmaria

AU - Jin, Zhaochen

AU - Stefani, Giulia

AU - Longhini, Federico

AU - Yi, Yang

AU - Guido, Stefania

AU - Yan, Jun

AU - Lu, Weihua

AU - Garofalo, Eugenio

AU - Bruni, Andrea

AU - Luo, Xiaoming

AU - Yan, Jun

AU - Qiu, Haibo

AU - Della Corte, Francesco

AU - Tang, Rui

AU - Yin, Jingjing

AU - Fontana, Tiziano

AU - Yu, Tao

AU - Cavuto, Silvio

AU - Navalesi, Paolo

AU - Ori, Carlo

AU - Li, Maoqin

AU - Zheng, Ruiqiang

PY - 2019

Y1 - 2019

N2 - Purpose: Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods: Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. Results: We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0–7.0) vs. 5.5 (4.0–9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0–12.0) vs. 9.0 (6.5–12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13–32) vs. 27(18–39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. Conclusions: In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.

AB - Purpose: Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods: Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. Results: We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0–7.0) vs. 5.5 (4.0–9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0–12.0) vs. 9.0 (6.5–12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13–32) vs. 27(18–39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. Conclusions: In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.

UR - http://hdl.handle.net/10447/331498

M3 - Article

VL - 45

SP - 62

EP - 71

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

ER -