Unidad de Cuidados Intensivos, Hospital General Universitario de Castellón - Castelló de Plana, Spain.
Unidad Predepartamental Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I - Castelló de la Plana, Spain.
Rev Bras Ter Intensiva. 2021 Oct 25;33(3):362-373. doi: 10.5935/0103-507X.20210059. eCollection 2021.
To determine the effectiveness of noninvasive ventilation versus conventional oxygen therapy in patients with acute respiratory failure after extubation failure.
A pragmatic clinical trial was conducted in an intensive care unit from March 2009 to September 2016. Patients on mechanical ventilation > 24 hours who developed acute respiratory failure after scheduled extubation were included and were assigned to noninvasive ventilation or conventional oxygen therapy. The primary objective was to reduce the reintubation rate. The secondary objectives were to improve respiratory parameters and reduce complications, the duration of mechanical ventilation, the intensive care unit stay, the hospital stay, and mortality in the intensive care unit, in the hospital, and 90 days after discharge. Factors correlated with reintubation were also analyzed.
Of a total of 2,574 patients, 77 were analyzed (38 in the noninvasive ventilation group and 39 in the conventional oxygen therapy group). Noninvasive ventilation reduced the respiratory and cardiac rates more rapidly than conventional oxygen therapy. Reintubation was less common in the noninvasive ventilation group [12 (32%) versus 22 (56%) in the conventional oxygen therapy group, relative risk 0.58 (95%CI 0.34 - 0.97), p = 0.039]. The rest of the parameters did not show significant differences. In the multivariate analysis, noninvasive ventilation protected against reintubation [OR 0.17 (95%CI 0.05 - 0.56), p = 0.004], while liver failure before extubation and the inability to maintain airway patency predisposed patients to reintubation.
The use of noninvasive ventilation in patients who failed extubation could be beneficial compared to conventional oxygen therapy.
比较无创通气与常规氧疗对拔管失败后急性呼吸衰竭患者的疗效。
这是一项 2009 年 3 月至 2016 年 9 月在重症监护病房进行的实用临床试验。纳入接受机械通气>24 小时且在计划拔管后发生急性呼吸衰竭的患者，并将其分配至无创通气或常规氧疗组。主要目的是降低再插管率。次要目的是改善呼吸参数，减少并发症，缩短机械通气时间、重症监护病房住院时间、医院住院时间以及重症监护病房、医院和出院后 90 天的死亡率。还分析了与再插管相关的因素。
共纳入 2574 例患者，其中 77 例（无创通气组 38 例，常规氧疗组 39 例）纳入分析。与常规氧疗组相比，无创通气组的呼吸和心率恢复得更快。无创通气组的再插管率较低[12（32%）比常规氧疗组的 22（56%），相对风险 0.58（95%CI 0.34-0.97），p=0.039]。其余参数差异无统计学意义。多变量分析显示，无创通气可降低再插管风险[比值比 0.17（95%CI 0.05-0.56），p=0.004]，而拔管前肝功能衰竭和无法保持气道通畅会增加再插管的风险。
与常规氧疗相比，拔管失败的患者使用无创通气可能有益。
