Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients
Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients
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DOI：
10.1097/01.ccm.0000186416.44752.72
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发表时间：
2005-11-01
影响因子：
8.8
通讯作者：
Navalesi, P
中科院分区：
文献类型：
--
作者：
Nava, S;Gregoretti, C;Navalesi, P
目的：与标准药物治疗（SMT）相比，无创通气（NIV）并不能减少未经选择的拔管后出现呼吸衰竭的患者重新插管的需要。本研究的目的是评估拔管后立即应用 NIV 是否能有效预防高危人群的拔管后呼吸衰竭。设计：多中心、随机对照研究。地点：多家医院。患者：97 名连续患者，具有相似的基线特征，需要 >48 小时的机械通气，并被认为有发生拔管后呼吸衰竭的风险（即患有高碳酸血症、充血性心力衰竭、无效咳嗽和过度呼吸的患者）气管支气管分泌物、不止一次撤机试验失败、不止一种合并症和上气道阻塞）。 干预：成功撤机试验后，患者被随机分配接受 NIV，在前 48 小时内每天≥8 小时或 SMT。主要结果是根据标准化标准需要重新插管。次要结局是重症监护病房和医院死亡率，以及在重症监护病房和医院的时间。测量和主要结果：与 SMT 组相比，NIV 组的再插管率较低（48 例中的 4 例 vs 49 例中的 12 例；p = 0.027）。重新插管的需要与较高的死亡风险相关（p
Objective: Compared with standard medical therapy (SMT), noninvasive ventilation (NIV) does not reduce the need for reintubation in unselected patients who develop respiratory failure after extubation. The goal of this study was to assess whether early application of NIV, immediately after extubation, is effective in preventing postextubation respiratory failure in an at-risk population.Design: Multiple-center, randomized controlled study.Setting: Multiple hospitals.Patients: Ninety-seven consecutive patients with similar baseline characteristics, requiring >48 hrs of mechanical ventilation and considered at risk of developing postextubation respiratory failure (i.e., patients who had hypercapnia, congestive heart failure, ineffective cough and excessive tracheobronchial secretions, more than one failure of a weaning trial, more than one comorbid condition, and upper airway obstruction).Interventions: After a successful weaning trial, the patients were randomized to receive NIV for >= 8 hrs a day in the first 48 hrs or SMT. Primary outcome was the need for reintubation according to standardized criteria. Secondary outcomes were intensive care unit and hospital mortality, as well as time spent in the intensive care unit and in hospital.Measurements and Main Results: Compared with the SMT group, the NIV group had a lower rate of reintubation (four of 48 vs. 12 of 49; p =.027). The need for reintubation was associated with a higher risk of mortality (p