Noninvasive positive-pressure ventilation for respiratory failure after extubation
Noninvasive positive-pressure ventilation for respiratory failure after extubation
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DOI：
10.1056/nejmoa032736
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发表时间：
2004-06-10
影响因子：
158.5
通讯作者：
Anzueto, A
中科院分区：
文献类型：
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作者：
Esteban, A;Frutos-Vivar, F;Anzueto, A
背景在拔管和停止机械通气后需要重新插管并不少见，并且与死亡率增加有关。无创正压通气已被认为是拔管后呼吸衰竭患者的一种有前途的治疗方法，但最近一项单中心随机试验发现无益处。我们进行了一项多中心，随机试验，以评估无创正压通气对死亡率的影响，在这种临床环境中。方法在8个国家的37个中心的患者谁是选择性拔管后，至少48小时的机械通气和谁在随后的48小时内呼吸衰竭被随机分配到无创正压通气，共有221名具有相似基线特征的患者被随机分配到无创通气组或无创通气组，（114例患者）或标准药物治疗（107例患者），当试验提前停止时，在中期分析后。无创通气组和标准治疗组在重新插管的需要方面没有差异（两组的重新插管率均为48%;无创通气组的相对风险为0.99; 95%置信区间为0.76 ~ 1.30）。重症监护室中无创通气组的死亡率高于标准治疗组（25%与14%;相对风险，1.78; 95%置信区间，1.03至3.20; P= 0.048），无创通气组从呼吸衰竭到重新插管的中位时间较长结论无创正压通气并不能预防拔管后出现呼吸衰竭的COPD患者再次插管或降低死亡率。
BACKGROUNDThe need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive-pressure ventilation has been suggested as a promising therapy for patients with respiratory failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting.METHODSPatients in 37 centers in eight countries who were electively extubated after at least 48 hours of mechanical ventilation and who had respiratory failure within the subsequent 48 hours were randomly assigned to either noninvasive positive-pressure ventilation by face mask or standard medical therapy.RESULTSA total of 221 patients with similar baseline characteristics had been randomly assigned to either noninvasive ventilation ( 114 patients) or standard medical therapy ( 107 patients) when the trial was stopped early, after an interim analysis. There was no difference between the noninvasive-ventilation group and the standard-therapy group in the need for reintubation ( rate of reintubation, 48 percent in both groups; relative risk in the noninvasive-ventilation group, 0.99; 95 percent confidence interval, 0.76 to 1.30). The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the standard-therapy group ( 25 percent vs. 14 percent; relative risk, 1.78; 95 percent confidence interval, 1.03 to 3.20; P= 0.048), and the median time from respiratory failure to reintubation was longer in the noninvasive-ventilation group ( 12 hours vs. 2 hours 30 minutes, P= 0.02).CONCLUSIONSNoninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have respiratory failure after extubation.