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Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial.
Am J Respir Crit Care Med. 2011 Sep 15; 184(6):672-9.AJ

Abstract

RATIONALE

The use of noninvasive ventilation (NIV) as an early weaning/extubation technique from mechanical ventilation remains controversial.

OBJECTIVES

To investigate NIV effectiveness as an early weaning/extubation technique in difficult-to-wean patients with chronic hypercapnic respiratory failure (CHRF).

METHODS

In 13 intensive care units, 208 patients with CHRF intubated for acute respiratory failure (ARF) who failed a first spontaneous breathing trial were randomly assigned to three groups: conventional invasive weaning group (n = 69), extubation followed by standard oxygen therapy (n = 70), or NIV (n = 69). NIV was permitted as rescue therapy for both non-NIV groups if postextubation ARF occurred. Primary endpoint was reintubation within 7 days after extubation. Secondary endpoints were: occurrence of postextubation ARF or death within 7 days after extubation, use of rescue postextubation NIV, weaning time, and patient outcomes.

MEASUREMENTS AND MAIN RESULTS

Reintubation rates were 30, 37, and 32% for invasive weaning, oxygen-therapy, and NIV groups, respectively (P = 0.654). Weaning failure rates, including postextubation ARF, were 54, 71, and 33%, respectively (P < 0.001). Rescue NIV success rates for invasive and oxygen-therapy groups were 45 and 58%, respectively (P = 0.386). By design, intubation duration was 1.5 days longer for the invasive group than in the two others. Apart from a longer weaning time in NIV than in invasive group (2.5 vs. 1.5 d; P = 0.033), no significant outcome difference was observed between groups.

CONCLUSIONS

No difference was found in the reintubation rate between the three weaning strategies. NIV decreases the intubation duration and may improve the weaning results in difficult-to-wean patients with CHRF by reducing the risk of postextubation ARF. The benefit of rescue NIV in these patients deserves confirmation.

Authors+Show Affiliations

Department of Medical Intensive Care, Rouen University Hospital, Rouen, France. Christophe.Girault@chu-rouen.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21680944

Citation

Girault, Christophe, et al. "Noninvasive Ventilation and Weaning in Patients With Chronic Hypercapnic Respiratory Failure: a Randomized Multicenter Trial." American Journal of Respiratory and Critical Care Medicine, vol. 184, no. 6, 2011, pp. 672-9.
Girault C, Bubenheim M, Abroug F, et al. Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. Am J Respir Crit Care Med. 2011;184(6):672-9.
Girault, C., Bubenheim, M., Abroug, F., Diehl, J. L., Elatrous, S., Beuret, P., Richecoeur, J., L'Her, E., Hilbert, G., Capellier, G., Rabbat, A., Besbes, M., Guérin, C., Guiot, P., Bénichou, J., & Bonmarchand, G. (2011). Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. American Journal of Respiratory and Critical Care Medicine, 184(6), 672-9. https://doi.org/10.1164/rccm.201101-0035OC
Girault C, et al. Noninvasive Ventilation and Weaning in Patients With Chronic Hypercapnic Respiratory Failure: a Randomized Multicenter Trial. Am J Respir Crit Care Med. 2011 Sep 15;184(6):672-9. PubMed PMID: 21680944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. AU - Girault,Christophe, AU - Bubenheim,Michael, AU - Abroug,Fekri, AU - Diehl,Jean Luc, AU - Elatrous,Souheil, AU - Beuret,Pascal, AU - Richecoeur,Jack, AU - L'Her,Erwan, AU - Hilbert,Gilles, AU - Capellier,Gilles, AU - Rabbat,Antoine, AU - Besbes,Mohamed, AU - Guérin,Claude, AU - Guiot,Philippe, AU - Bénichou,Jacques, AU - Bonmarchand,Guy, AU - ,, PY - 2011/6/18/entrez PY - 2011/6/18/pubmed PY - 2012/1/6/medline SP - 672 EP - 9 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 184 IS - 6 N2 - RATIONALE: The use of noninvasive ventilation (NIV) as an early weaning/extubation technique from mechanical ventilation remains controversial. OBJECTIVES: To investigate NIV effectiveness as an early weaning/extubation technique in difficult-to-wean patients with chronic hypercapnic respiratory failure (CHRF). METHODS: In 13 intensive care units, 208 patients with CHRF intubated for acute respiratory failure (ARF) who failed a first spontaneous breathing trial were randomly assigned to three groups: conventional invasive weaning group (n = 69), extubation followed by standard oxygen therapy (n = 70), or NIV (n = 69). NIV was permitted as rescue therapy for both non-NIV groups if postextubation ARF occurred. Primary endpoint was reintubation within 7 days after extubation. Secondary endpoints were: occurrence of postextubation ARF or death within 7 days after extubation, use of rescue postextubation NIV, weaning time, and patient outcomes. MEASUREMENTS AND MAIN RESULTS: Reintubation rates were 30, 37, and 32% for invasive weaning, oxygen-therapy, and NIV groups, respectively (P = 0.654). Weaning failure rates, including postextubation ARF, were 54, 71, and 33%, respectively (P < 0.001). Rescue NIV success rates for invasive and oxygen-therapy groups were 45 and 58%, respectively (P = 0.386). By design, intubation duration was 1.5 days longer for the invasive group than in the two others. Apart from a longer weaning time in NIV than in invasive group (2.5 vs. 1.5 d; P = 0.033), no significant outcome difference was observed between groups. CONCLUSIONS: No difference was found in the reintubation rate between the three weaning strategies. NIV decreases the intubation duration and may improve the weaning results in difficult-to-wean patients with CHRF by reducing the risk of postextubation ARF. The benefit of rescue NIV in these patients deserves confirmation. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/21680944/Noninvasive_ventilation_and_weaning_in_patients_with_chronic_hypercapnic_respiratory_failure:_a_randomized_multicenter_trial_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.201101-0035OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -