Non-invasive Ventilation and Weaning in Chronic Hypercapnic Respiratory Failure Patients: A Randomized Multicenter Trial.
Am J Respir Crit Care Med. 2011 Jun 16;
Authors: Girault C, Bubenheim M, Abroug F, Diehl JL, 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,
RATIONALE: The interest of non-invasive 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 chronic hypercapnic respiratory failure (CHRF) patients. METHODS: In 13 ICUs, 208 CHRF patients 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 post-extubation ARF occurred. Primary endpoint was reintubation within seven days following extubation. Secondary endpoints were: occurrence of post-extubation ARF or death within, use of rescue post-extubation NIV, weaning time, and patients outcome. MEASUREMENTS AND MAIN RESULTS: Reintubation rates were 30%, 37% and 32% for invasive weaning, oxygen-therapy and NIV group, respectively (p=0.654). Weaning failure rates, including post-extubation 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 day 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 days; 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 CHRF patients by reducing the risk of post-extubation ARF. The benefit of rescue NIV in these patients deserves confirmation. Clinical trials registration information available at www.clinicaltrials.gov, i.d. NCT00213499.
PMID: 21680944 [PubMed - as supplied by publisher]