¡°While NIV used as a weaning technique did not reduce the risk of reintubation as compared with conventional weaning and standard oxygen therapy, we do think the reduced risk of reintubation or death with NIV used as rescue therapy bears further investigation,¡± said lead investigator Christophe Girault, MD.
The study was published online ahead of the print edition of the American Thoracic Society¡¯s American Journal of Respiratory and Critical Care Medicine.
Researchers consecutively recruited patients with chronic hypercapnic respiratory failure (CHRF) from 13 French and Tunisian ICUs between January 2002 and March 2006. Eligible patients had to have been intubated for at least 48 hours and failed a spontaneous breathing trial (SBT). Nearly one-third of 388 ventilated patients passed the SBT and were able to breathe on their own. Of the remaining patients, 208 failed the spontaneous breathing trial and were randomized to one of three ventilation-weaning strategies: ¡°conventional weaning,¡± where patients remained intubated and underwent one or more daily SBT with T-piece or pressure support ventilation (PSV) with or without positive end expiratory pressure (PEEP), and a progressive decrease in PSV level (until ¡Ü 7 cmH2O); extubation followed by standard oxygen therapy¡ªadministered via a nasal cannula or venturi mask; or extubation followed by NIV administered through a facial mask. This was the first randomized, controlled study of its sort in CHRF patients.
The primary endpoint evaluated was the need for reintubation within seven days of extubation. The secondary endpoints were secondary occurrence of ARF or death from all causes within seven days of extubation. The researchers also evaluated time to rescue post-extubation NIV and the probability of reintubation or death within seven days following its initiation; ICU and hospital length of stay and survival; and respiratory condition on hospital discharge.
They found that the probability of reintubation was not significantly different between the three weaning strategies, and that the causes of reintubation were similar between groups. However, post-intubation ARF in the NIV group was significantly lower than in others.
¡°Our results suggest that rescue NIV might be useful to avoid reintubation when post-extubation ARF occurs in these patients,¡± said Dr. Girault.
These results are consistent with previously published results, including those of the VENISE trial, which involved a large cohort of CHRF patients considered to be potentially difficult-to-wean.
¡°NIV allowed to decrease the intubation duration as compared to invasive weaning, without increasing the risk of weaning failure in terms of reintubation,¡± he continued. ¡°NIV might, in fact, allow earlier extubation but not necessarily more rapidly ¡®de-ventilation¡¯ in difficult-to-wean CHRF patients.¡±
Importantly, the study also points to a possible benefit of NIV as a rescue therapy to avoid reintubation. ¡°Indeed, it was applied frequently in the two non-NIV groups and reduced the risk of reintubation or death by 45 percent in patients assigned to invasive weaning and 58 percent in those assigned to the oxygen therapy group,¡± said Dr. Girault.
¡°Rescue NIV is currently not recommended for non-selected medical patients because until now there has been no proven benefit and even potential harmful outcome,¡± he continued. ¡°However, this study suggests that the standard should perhaps be re-evaluated in light of this, and further research, if the result proves consistent.¡±
Further research should be done, he continued. For next steps, Dr. Girault would like to see a randomized, controlled trial with NIV as a weaning technique but with post-extubation ARF occurrence as the primary endpoint, and another randomized, controlled trial to confirm the potential benefit of NIV used as rescue therapy in this specific population.Contact for article: Dr. Christophe Girault,M.D., Department of Medical Intensive Care, Rouen University Hospital, and UPRES EA 3830-IFRMP.23, Institute for Biomedical Research, Rouen University, 1, rue de Germont 76031 Cedex, France.
Keely Savoie | Newswise Science News
Cardiac diseases: when less is more
30.03.2017 | Universitätsspital Bern
TSRI researchers develop new method to 'fingerprint' HIV
29.03.2017 | Scripps Research Institute
The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.
To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
30.03.2017 | Physics and Astronomy
30.03.2017 | Studies and Analyses
30.03.2017 | Life Sciences