Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 Accéder directement au contenu
Article Dans Une Revue Annals of Intensive Care Année : 2021

Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial

Arnaud Thille
Rémi Coudroy
  • Fonction : Auteur
Mai-Anh Nay
Arnaud Gacouin
  • Fonction : Auteur
Maxens Decavèle
  • Fonction : Auteur
Romain Sonneville
François Beloncle
  • Fonction : Auteur
Christophe Girault
  • Fonction : Auteur
Laurence Dangers
  • Fonction : Auteur
Alexandre Lautrette
Quentin Levrat
  • Fonction : Auteur
Anahita Rouzé
  • Fonction : Auteur
Emmanuel Vivier
Jean-Baptiste Lascarrou
Jean-Damien Ricard
  • Fonction : Auteur
Keyvan Razazi
  • Fonction : Auteur
Guillaume Barberet
  • Fonction : Auteur
Christine Lebert
  • Fonction : Auteur
Alexandre Massri
  • Fonction : Auteur
Jeremy Bourenne
  • Fonction : Auteur
Gael Pradel
  • Fonction : Auteur
Pierre Bailly
  • Fonction : Auteur
Nicolas Terzi
Jean Dellamonica
Guillaume Lacave
  • Fonction : Auteur
René Robert
Stéphanie Ragot
  • Fonction : Auteur
Jean-Pierre Frat

Résumé

Abstract Background Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation. Results Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone . The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, − 14% (95% CI − 27% to − 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference − 4% (95% CI − 14% to 5%); p = 0.40]. Conclusions In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017)
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Dates et versions

hal-03518792 , version 1 (10-04-2024)

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Arnaud Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, et al.. Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial. Annals of Intensive Care, 2021, 11 (1), pp.30. ⟨10.1186/s13613-021-00823-7⟩. ⟨hal-03518792⟩

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