¡°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
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
Better equipped in the fight against lung cancer
16.05.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.
Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...
A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.
Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
18.05.2018 | Power and Electrical Engineering
18.05.2018 | Information Technology
18.05.2018 | Information Technology