Effect of Noninvasive Ventilation After Unplanned Extubation
Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as...
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Published in | Respiratory care Vol. 64; no. 3; pp. 248 - 254 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Daedalus Enterprises, Inc
01.03.2019
Daedalus Enterprises Inc |
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Abstract | Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation.
Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis.
A total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3-73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36-54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV,
= 10; rescue NIV,
= 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5-49.2] vs 0.46 [0.25-1] h,
= .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7-24.5] vs 6 [3-14] d, respectively,
= .004; and 9 [3-22] vs 3 [1-7.3] d, respectively,
= .003).
NIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure. |
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AbstractList | BACKGROUND: Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. METHODS: Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis. RESULTS: A total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3-73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36-54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV, n = 10; rescue NIV, n = 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5-49.2] vs 0.46 [0.25-1] h, P = .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7-24.5] vs 6 [3-14] d, respectively, P = .004; and 9 [3-22] vs 3 [1-7.3] d, respectively, P = .003). CONCLUSIONS: NIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure. Key words: unplanned extubation; noninvasive ventilation; re-intubation; outcome; ICU; prophylaxis. [Respir Care 2019;64(3):248-254. [C] 2019 Daedalus Enterprises] BACKGROUNDOur study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. METHODSRetrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis. RESULTSA total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3-73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36-54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV, n = 10; rescue NIV, n = 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5-49.2] vs 0.46 [0.25-1] h, P = .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7-24.5] vs 6 [3-14] d, respectively, P = .004; and 9 [3-22] vs 3 [1-7.3] d, respectively, P = .003). CONCLUSIONSNIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure. Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis. A total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3-73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36-54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV, = 10; rescue NIV, = 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5-49.2] vs 0.46 [0.25-1] h, = .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7-24.5] vs 6 [3-14] d, respectively, = .004; and 9 [3-22] vs 3 [1-7.3] d, respectively, = .003). NIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure. |
Audience | General |
Author | Sztrymf, Benjamin Dumenil, Anne Sylvie Moneger, Guy Millereux, Maude Gouezel, Corentin Hamzaoui, Olfa Jacobs, Frédéric Demars, Nadège Trouiller, Pierre Kudela, Agathe Prat, Dominique |
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Snippet | Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation.
Retrospective analysis of prospectively collected... BACKGROUND: Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. METHODS: Retrospective analysis of... BACKGROUNDOur study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation. METHODSRetrospective analysis of... |
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SubjectTerms | Academic Medical Centers Adult Aged Airway Extubation Complications and side effects Critical Care - methods Critical care medicine Databases, Factual Female Follow-Up Studies France Hospital Mortality Humans Intensive Care Units Intratracheal intubation Length of Stay Life Sciences Male Mechanical ventilation Methods Middle Aged Noninvasive Ventilation - methods Patient outcomes Physicians Prophylaxis Respiratory insufficiency Respiratory Insufficiency - diagnosis Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Retreatment - methods Retrospective Studies Risk Assessment Statistics, Nonparametric Sufentanil Survival Rate Treatment Outcome |
Title | Effect of Noninvasive Ventilation After Unplanned Extubation |
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