机构：[1]Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitie-Salpetriere Hospital, Assistance Publique Hopitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France.[2]Adult Intensive Care Unit, Department of Peri‑Operative Medicine, University Hospital Estaing, University of Auvergne, Clermont‑Ferrand, France.[3]Medecine Intensive Reanimation, University Hospital Centre Dijon, University of Bourgogne- Franche Comte, Dijon, France.[4]Department of Emergency Medicine, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, Zhejiang, China.[5]Critical Care Medicine Department, Peking University People’s Hospital, Beijing, China.[6]Emergency Department and Emergency/Medical Intensive Care Unit, 1st Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China.内科科室急诊医学科昆明医科大学附属第一医院[7]Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, University of Lorraine, Nancy, France.[8]Anesthesiology, Surgical Sciences and Perioperative Medicine, University of Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil.[9]Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont‑Ferrand, France.[10]Multidisciplinary Intensive Care Unit, Anaesthesia and Critical Care Pole, Gabriel Montpied Hospital, Clermont‑Ferrand, France.[11]Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalo-Universitaire Arpet II de Nice, University of Nice Sophia Antipolis, Nice, France.[12]Department of Anaesthesia and Intensive Care, Centre Hospitalo-Universitaire Grenoble- Alpes, University Grenoble-Alpes, Grenoble, France.[13]Multidisciplinary Intensive Care Unit, Department of Anaesthesia and Critical Care Medicine, Hospices Civils de Lyon, Lyon-Sud, Lyon, France.[14]Intensive Care Unit, Federal University of Rio Grande do Sul, Ernesto Dornelles Hospital, Moinhos de Vento Hospital, Porto Alegre, Brazil
Background Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF. Methods Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS) >= 14 assessed during the spontaneous breathing trial, were included in a French-Chinese randomised controlled trial. PRF was defined by 2 among the following signs: SpO2 < 90%; Respiratory rate > 30 /min; hypercapnia; haemodynamic and/or neurological disturbances of respiratory origin. In the intervention group, prophylactic NIV alternating with HFNO was administered for 48 h following extubation. In the control group, conventional oxygen was used. Clinicians were informed on the LUS in the intervention group, those in the control group remained blind. The primary outcome was the incidence of PRF 48 h after extubation. Secondary outcomes were incidence of PRF and reintubation at day 7, number of ventilator-free days at day 28, length of ICU stay and mortality at day 28 and 90. Results Two hundred and forty patients were randomised and 227 analysed (intervention group = 128 and control group = 99). PRF at H48 was reduced in the intervention group compared to the control group: relative risk 0.52 (0.31 to 0.88), p = 0.01. The benefit persisted at day 7: relative risk 0.62 (0.44 to 0.96), p = 0.02. Weaning failure imposing reconnection to mechanical ventilation was not reduced. In patients who developed PRF and were treated by rescue NIV, reintubation was avoided in 44% of control patients and in 12% of intervention patients (p = 0.008). Other secondary outcomes were not different between groups. From a resource utilisation standpoint, prophylactic NIV alternating with HFNO was more demanding and costly than conventional oxygen with rescue NIV to achieve same clinical outcome. Conclusions Compared to conventional oxygenation, prophylactic NIV alternating with HFNO significantly reduced postextubation respiratory failure but failed to reduce reintubation rate and mortality in patients without COPD at high risk of extubation failure. Prophylactic NIV alternating with HFNO was as efficient as recue NIV to treat postextubation respiratory failure.
基金：
The "Programme Hospitalier de Recherche Clinique Regional 2014" of the French Ministry of Health through the University Hospital of Poitiers, Poitiers, France [PHRCI-14-003]
第一作者机构：[1]Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitie-Salpetriere Hospital, Assistance Publique Hopitaux de Paris, Sorbonne University, GRC 29, DMU DREAM, Paris, France.
通讯作者：
推荐引用方式(GB/T 7714)：
Rouby Jean-Jacques,Perbet Sebastien,Quenot Jean-Pierre,et al.Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial[J].CRITICAL CARE.2024,28(1):doi:10.1186/s13054-024-05166-w.
APA：
Rouby, Jean-Jacques,Perbet, Sebastien,Quenot, Jean-Pierre,Zhang, Mao,Andreu, Pascal...&Pereira, Bruno.(2024).Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial.CRITICAL CARE,28,(1)
MLA：
Rouby, Jean-Jacques,et al."Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial".CRITICAL CARE 28..1(2024)
医学