Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation

Chu, Chao-Ting; Liu, Chin-Jung; Yen, Suh-May; Chou, Wen-Yu; Kung, Pei‐Tseng; Tsai, Yuh-Show; Tsai, Wen‐Chen

doi:10.4187/respcare.05649

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…However, in our study the main reasons for intubation were acute exacerbation of COPD and pneumonia. Previous studies have demonstrated that COPD and pneumonia are two risk factors for EF 26,27 . This may be the reason for the high rate of EF in our study.…”

Section: Discussionmentioning

confidence: 50%

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Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Jiang

Pan

2020

Internal Medicine Journal

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Background: Extubation failure (EF) is high in patients on mechanical ventilation for more than 7 days. However, strategies to prevent EF in this population are lacking. Aims: To evaluate the efficacy of preventive use of noninvasive ventilation in patients on mechanical ventilation for more than 7 days. Methods: We performed a retrospective study in an intensive care unit of a teaching hospital. We enrolled patients who received mechanical ventilation for more than 7 days and successfully completed a weaning trial. After extubation, patients who immediately received non-invasive ventilation (NIV) were classified as the NIV group, and those who received conventional oxygenation therapy only were classified as the usual care group. Results: We enrolled 95 patients in the NIV group and 61 patients in the usual care group. NIV is associated with reduced risk of EF compared to usual care both 72 h following extubation (11.6% vs 32.8%, P < 0.01, for the overall cohort; 8.6% vs 42.9%, P < 0.01, for the propensity-matched cohort) and 7 days following extubation (25.3% vs 45.9%, P < 0.01, for the overall cohort; 28.6% vs 51.4%, P = 0.09, for the propensity-matched cohort). Within 7 days of extubation, the NIV group had a lower proportion of EF than the controls (log rank test: P < 0.01 and P = 0.02 for the overall and propensity-matched cohorts, respectively). Conclusions: In patients on mechanical ventilation for more than 7 days, preventive use of NIV is associated with a reduction in EF.

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Section: Discussionmentioning

confidence: 50%

“…Previous studies have demonstrated that COPD and pneumonia are two risk factors for EF. 26,27 This may be the reason for the high rate of EF in our study. Therefore, it should be cautious to extrapolate our results to other centres in which the proportion of COPD and pneumonia is low.…”

Section: Discussionmentioning

confidence: 70%

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Jiang

Pan

2020

Internal Medicine Journal

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“…Moreover, Zhou et al showed that NPPV was associated with reductions in mortality and post-extubation respiratory failure rates compared to COT. COPD is a risk factor for reintubation after extubation and predisposes patients to hypercapnia during SBT [46]. Thus, NPPV is more effective than COT for patients with hypercapnia after extubation [50], which possibly led to differences in results between our study and that of Zhou et al Furthermore, including trials with many COPD patients potentially increases the patient heterogeneity.…”

Section: Discussionmentioning

confidence: 65%

“…However, Kondo et al showed that NPPV decreased reintubation and mortality rates more effectively than COT despite the complete exclusion of COPD patients from the study [45]. In our study, we excluded studies with COPD patients constituting >50% of the study population, as COPD is a risk factor for post-extubation respiratory failure [46]. Thus, the abovementioned exclusion potentially caused a difference between the effectiveness of NPPV and COT in the systematic reviews included in the NMA.…”

Section: Discussionmentioning

confidence: 96%

Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

Yasuda¹,

Okano²,

Mayumi³

et al. 2021

Preprint

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Background: High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, COT) in reducing the mortality and reintubation risk.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients aged ≥16 years who underwent invasive mechanical ventilation for >12 hours for acute respiratory failure and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effects meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results: After evaluating 4,631 records, 15 studies and 2,600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval], 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared with COT use. The associations of mortality with NPPV and HFNC in either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval], 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).Conclusion: NPPV or HFNC use may reduce endotracheal reintubation risk, but not short-term mortality risk.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).

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“…Therefore, guidelines recommend that NIV be used preventively in high-risk patients 10,11. COPD is a risk factor for extubation failure 12,13. It has been demonstrated that prophylactic NIV benefits patients who exhibit this risk factor 6,7.…”

Section: Introductionmentioning

confidence: 99%

<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

Gong¹,

Han²,

Duan³

et al. 2019

COPD

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BackgroundProphylactic noninvasive ventilation (NIV) after scheduled extubation can benefit patients with chronic respiratory disorders, among which chronic obstructive pulmonary disease (COPD) is a significant example. However, it is not known whether all COPD patients benefit from prophylactic NIV.MethodsWe performed a post hoc analysis of prospectively collected data. COPD patients who successfully completed a spontaneous breathing trial were enrolled. In the prophylactic NIV group, NIV was applied immediately after extubation. In the usual care group, conventional oxygen therapy was used. Patients were followed up to 90 days post-extubation.ResultsAmong patients with PaCO2 > 45 mmHg, 128 and 40 received prophylactic NIV and usual care, respectively. Prophylactic NIV led to lower rates of re-intubation (4% vs 30% at 72 h and 11% vs 35% at 7 days, both p < 0.01) and hospital mortality (18% vs 40%, p < 0.01) than usual care. The proportion of 90-day mortality was also lower in the prophylactic NIV group (log rank test, p = 0.04). Among patients with PaCO2 ≤ 45 mmHg, 32 and 21 received prophylactic NIV and usual care, respectively. In this cohort however, prophylactic NIV neither reduced re-intubation (6% vs 5% at 72 h, p > 0.99, and 9% vs 14% at 7 days, p = 0.67) nor hospital mortality (19% vs 24%, p = 0.74). The proportion of 90-day mortality did not differ between the two groups (log rank test, p = 0.79).ConclusionThis exploratory study shows that prophylactic NIV benefits COPD patients with PaCO2 > 45 mmHg, but it may not benefit those with PaCO2 ≤ 45 mmHg. Further study with a larger sample size is required to confirm this.

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Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation

Cited by 8 publications

References 28 publications

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

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Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation

Cited by 8 publications

References 28 publications

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Post-extubation&nbsp;Oxygenation Strategies&nbsp;and Mortality and&nbsp;Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

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Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis