Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial.
Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial.
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DOI：
10.1007/s00134-022-06919-3
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发表时间：
2022-12
影响因子：
38.9
通讯作者：
Roca, Oriol
中科院分区：
文献类型：
--
作者：
Hernandez, Gonzalo;Paredes, Irene;Moran, Francisco;Buj, Marcos;Colinas, Laura;Luisa Rodriguez, Maria;Velasco, Alfonso;Rodriguez, Patricia;Jose Perez-Pedrero, Maria;Suarez-Sipmann, Fernando;Canabal, Alfonso;Cuena, Rafael;Blanch, Lluis;Roca, Oriol
高流量鼻插管（HFNC）氧疗在预防拔管失败高风险异质人群再次插管方面不劣于无创通气（NIV）。然而，某些亚组患者的结局可能不同。因此，我们的目的是确定在预防具有≥ 4个风险因素（拔管失败风险极高）的患者再次插管方面，主动湿化的NIV是否优于HFNC上级。在西班牙两个重症监护病房进行的随机对照试验（2020年6月至2021年6月）。纳入准备按计划拔管且具有≥ 4项以下再次插管风险因素的患者：年龄> 65岁，拔管当天急性生理学和慢性健康评估II评分> 12，体重指数> 30，分泌物管理不足，脱机困难或延长，≥ 2种合并症，提示机械通气的急性心力衰竭，中度至重度慢性阻塞性肺疾病，完成自主呼吸试验时出现气道通畅问题、机械通气延长或高碳酸血症。患者在拔管后48 h随机接受NIV主动湿化或HFNC。主要结局是拔管后7天内的再插管率。次要结局包括拔管后呼吸衰竭、呼吸道感染、败血症、多器官衰竭、住院时间、死亡率、不良事件和重新插管时间。在182例患者中（平均年龄60 [标准差（SD），15]岁; 117例[64%]男性），92例接受NIV，90例接受HFNC。21例（23.3%）接受NIV的患者需要重新插管，35例（38.8%）接受HFNC的患者需要重新插管（差异为-15.5%; 95%置信区间（CI）为-28.3至1%）。接受NIV治疗的患者住院时间较短（20 [12 <$36.7]天vs 26.5 [15 <$45]天，差异6.5 [95%CI 0.5-21.1]）。未观察到其他次要结局的其他差异。在拔管失败风险极高的成人危重患者中，NIV+主动湿化在预防再次插管方面上级HFNC。在线版本包含补充材料，可通过10.1007/s 00134 -022-06919-3获得。
High-flow nasal cannula (HFNC) oxygen therapy was noninferior to noninvasive ventilation (NIV) for preventing reintubation in a heterogeneous population at high-risk for extubation failure. However, outcomes might differ in certain subgroups of patients. Thus, we aimed to determine whether NIV with active humidification is superior to HFNC in preventing reintubation in patients with ≥ 4 risk factors (very high risk for extubation failure). Randomized controlled trial in two intensive care units in Spain (June 2020‒June 2021). Patients ready for planned extubation with ≥ 4 of the following risk factors for reintubation were included: age > 65 years, Acute Physiology and Chronic Health Evaluation II score > 12 on extubation day, body mass index > 30, inadequate secretions management, difficult or prolonged weaning, ≥ 2 comorbidities, acute heart failure indicating mechanical ventilation, moderate-to-severe chronic obstructive pulmonary disease, airway patency problems, prolonged mechanical ventilation, or hypercapnia on finishing the spontaneous breathing trial. Patients were randomized to undergo NIV with active humidification or HFNC for 48 h after extubation. The primary outcome was reintubation rate within 7 days after extubation. Secondary outcomes included postextubation respiratory failure, respiratory infection, sepsis, multiorgan failure, length of stay, mortality, adverse events, and time to reintubation. Of 182 patients (mean age, 60 [standard deviation (SD), 15] years; 117 [64%] men), 92 received NIV and 90 HFNC. Reintubation was required in 21 (23.3%) patients receiving NIV vs 35 (38.8%) of those receiving HFNC (difference −15.5%; 95% confidence interval (CI) −28.3 to −1%). Hospital length of stay was lower in those patients treated with NIV (20 [12‒36.7] days vs 26.5 [15‒45] days, difference 6.5 [95%CI 0.5–21.1]). No additional differences in the other secondary outcomes were observed. Among adult critically ill patients at very high-risk for extubation failure, NIV with active humidification was superior to HFNC for preventing reintubation. The online version contains supplementary material available at 10.1007/s00134-022-06919-3.
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影响因子：
158.5
作者：
Esteban, A;Frutos-Vivar, F;Anzueto, A
通讯作者：
Anzueto, A
影响因子：
120.7
作者：
Thille, Arnaud W.;Muller, Gregoire;Buscot, Matthieu
通讯作者：
Buscot, Matthieu
影响因子：
8.8
作者：
Canet, Jaume;Gallart, Lluis;Sanchis, Joaquin
通讯作者：
Sanchis, Joaquin
影响因子：
38.9
作者：
Lellouche, Francois;Maggiore, Salvatore Maurizio;Brochard, Laurent
通讯作者：
Brochard, Laurent
影响因子：
8.8
作者：
Nava, S;Gregoretti, C;Navalesi, P
通讯作者：
Navalesi, P