Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER)

Vargas, Frédéric; Clavel, M.; Sanchez-Verlan, Pascale; Garnier, Sylvain; Boyer, Alexandre; Bui, Hoang Nam; Clouzeau, Benjamin; Sazio, Charline; Kerchache, Aïssa; Guisset, Olivier; Bénard, Antoine; Asselineau, Julien; Gauche, Bernard; Gruson, Didier; Silva, Stein; Vignon, Philippe; Hilbert, Gilles

doi:10.1007/s00134-017-4785-1

Cited by 41 publications

(48 citation statements)

References 39 publications

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“…After excluding 334 duplicates and 3134 irrelevant citations, we reviewed the full text of the remaining 62 records. Finally, a total of 17 eligible RCTs [23,[26][27][28][37][38][39][40][41][42][43][44][45][46][47][48][49], representing 3341 patients, were included in this NMA. The PRISMA flowchart for study inclusion is shown in Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…Of the 17 included RCTs [23,[26][27][28][37][38][39][40][41][42][43][44][45][46][47][48][49], 10 [23, 26-28, 38, 41, 43-46] were multicenter, and 7 [37,39,40,42,[47][48][49] were single-center. All included RCTs were published in the last 15 years, and the number of participants ranged from 38 to 614.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Among these trials, however, 9 trials [37-40, 42, 44, 47-49] fulfilled the predefined criteria of a high risk of extubation failure in our NMA and were therefore classified as high risk, and the risk in the remaining 2 trials [43,46] was unclear. NIV was compared with COT in 9 trials [26,[37][38][39][40][41][42][43][44]. Four trials compared HFOT with COT [28,[45][46][47].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

Zhou

Yao

Dong³

et al. 2020

Crit Care

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Background: Respiratory support has been increasingly used after extubation for the prevention of re-intubation and improvement of prognosis in critically ill medical patients. However, the optimal respiratory support method is still under debate. This network meta-analysis (NMA) aims to evaluate the comparative effectiveness of various respiratory support methods used for preventive purposes after scheduled extubation in critically ill medical patients. Methods: A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Study selection, data extraction, and quality assessments were performed in duplicate. The primary outcomes included re-intubation rate and short-term mortality. Results: Seventeen RCTs comprising 3341 participants with 4 comparisons were included. Compared with COT, NIV significantly reduced the re-intubation rate [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.39 to 0.77; moderate quality of evidence] and short-term mortality (RR 0.66, 95% CI 0.48 to 0.91; moderate quality of evidence). Compared to COT, HFOT had a beneficial effect on the re-intubation rate (RR 0.55, 95% CI 0.35 to 0.86; moderate quality of evidence) but no effect on short-term mortality (RR 0.79, 95% CI 0.56 to 1.12; low quality of evidence). No significant difference in the re-intubation rate or short-term mortality was found among NIV, HFOT, and HFOT+NIV. The treatment rankings based on the surface under the cumulative ranking curve (SUCRA) from best to worst for re-intubation rate were HFOT+NIV (95.1%), NIV (53.4%), HFOT (51.2%), and COT (0.3%), and the rankings for shortterm mortality were NIV (91.0%), HFOT (54.3%), HFOT+NIV (43.7%), and COT (11.1%). Sensitivity analyses of trials with a high risk of extubation failure for the primary outcomes indicated that the SUCRA rankings were comparable to

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

Zhou

Yao

Dong³

et al. 2020

Crit Care

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“…6 Studies showed that after a planned extubation, preventive use of NIV was associated with reduced risk of reintubation in patients with these risk factors. [18][19][20]31 In our study, we did not predefine how NIV should be used after extubation. The attending physicians were more likely to order the use of NIV in patients with risk factors.…”

Section: Discussionmentioning

confidence: 98%

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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“…Für einen generellen prophylaktischen Einsatz der NIV nach konventionellem Weaning gibt es keine positiven Daten betreffend die Endpunkte Mortalität oder Re-Intubation, jedoch Empfehlungen bei Hochrisikopatienten, zu denen COPD-Patienten gezählt werden. [26,27]. NIV bei neuerlichem respiratorischem Versagen nach Extubation (Postextubation Failure) zeigt keinen Vorteil [28,29].…”

Section: Weaning Bei Copdunclassified

Beatmung bei COPD: von der Präklinik bis zur außerklinischen Beatmung. Eine Übersicht des Arbeitskreises für Beatmung und Intensivmedizin der österreichischen Gesellschaft für Pneumologie

Kink¹,

Erler²,

Fritz

et al. 2019

Wien Klin Wochenschr

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This paper was created by the Austrian Society of Pneumology (Working group Ventilation and Intensive Care) to summarize the specific characteristics of mechanical ventilation in patients presenting with chronic obstructive pulmonary disease (COPD). The main differences in pathophysiology and mechanical ventilation are shown, including acute respiratory failure and out-of-hospital mechanical ventilation.

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Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER)

Abstract: Early NIV performed following a sequential protocol for the first 48 h after extubation decreased the risk of respiratory failure in patients with chronic respiratory disorders. Reintubation and mortality did not differ between NIV and conventional oxygen therapy.

Cited by 41 publications

References 39 publications

Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

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

Beatmung bei COPD: von der Präklinik bis zur außerklinischen Beatmung. Eine Übersicht des Arbeitskreises für Beatmung und Intensivmedizin der österreichischen Gesellschaft für Pneumologie

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