Early extubation with immediate non-invasive ventilation versus standard weaning in intubated patients for coronavirus disease 2019: a retrospective multicenter study

被引：10

作者：

Cammarota, Gianmaria ^{[1
]}

Vaschetto, Rosanna ^{[2
,3
]}

Azzolina, Danila ^{[3
]}

De Vita, Nello ^{[3
]}

Olivieri, Carlo ^{[4
]}

Ronco, Chiara ^{[4
]}

Longhini, Federico ^{[5
]}

Bruni, Andrea ^{[5
]}

Colombo, Davide ^{[6
]}

Pissaia, Claudio ^{[7
]}

Prato, Federico ^{[7
]}

Maestrone, Carlo ^{[8
]}

Maestrone, Matteo ^{[8
]}

Vetrugno, Luigi ^{[9
]}

Bove, Tiziana ^{[9
]}

Lemut, Francesco ^{[10
]}

Taretto, Elisa ^{[10
]}

Locatelli, Alessandro ^{[11
]}

Barzaghi, Nicoletta ^{[11
]}

Cerrano, Martina ^{[11
]}

Ravera, Enrico ^{[12
]}

Zanza, Christian ^{[12
,13
]}

Selva, Andrea Della ^{[12
]}

Blangetti, Ilaria ^{[14
]}

Salvo, Francesco ^{[14
]}

Racca, Fabrizio ^{[13
]}

Longhitano, Yaroslava ^{[13
]}

Boscolo, Annalisa ^{[15
]}

Sguazzotti, Ilaria ^{[2
]}

Bonato, Valeria ^{[13
]}

Grossi, Francesca ^{[2
]}

Crimaldi, Federico ^{[3
]}

Perucca, Raffaella ^{[2
]}

Boniolo, Ester ^{[3
]}

Verdina, Federico ^{[3
]}

Vignazia, Gian Luca ^{[2
]}

Santangelo, Erminio ^{[3
]}

Tarquini, Riccardo ^{[3
]}

Zanoni, Marta ^{[2
]}

Messina, Antonio ^{[16
]}

Marin, Matteo ^{[9
]}

Bacigalupo, Paola ^{[10
]}

Sileci, Graziana ^{[10
]}

Sella, Nicolo ^{[17
]}

De Robertis, Edardo ^{[1
]}

Corte, Francesco Della ^{[2
,3
]}

Navalesi, Paolo ^{[15
,17
]}

机构：

[1] Univ Perugia, Dipartimento Med & Chirurg, Perugia, Italy

[2] AAzienda Osped Univ Maggiore della Carita, Dept Anesthesia & Intens Care, Novara, Italy

[3] Univ Piemonte Orientale, Translat Med Dept, Novara, Italy

[4] Osped St Andrea, Anesthesia & Intens Care, Vercelli, Italy

[5] Magna Graecia Univ Catanzaro, Dept Med & Surg Sci, Catanzaro, Italy

[6] Osped Ss Trinita, Dept Anesthesia & Crit Care, Borgomanero, Italy

[7] Osped Inferm Biella, Dept Anesthesia & Crit Care, Biella, Italy

[8] Presidio Osped Domodossola & Verbania ASL VCO, Dept Anesthesia & Crit Care, Domodossola Verbania, Italy

[9] Univ Udine, Dept Med, Anesthesia & Intens Care Clin, Udine, Italy

[10] Osped Monsignor Giovanni Galliano, Dept Anesthesia & Crit Care, Acqui Terme, Italy

[11] Azienda Osped Santa Croce & Carle, Dept Anesthesia & Crit Care, Cuneo, Italy

[12] Pietro Ferrero Hosp, Dept Emergency Med Anesthesia & Crit Care Michele, Verduno, Italy

[13] Azienda Osped SS Antonio & Biagio & Cesare Arrigo, Dept Anesthesia & Intens Care, Alessandria, Italy

[14] Osped Regina Montis Regalis, Dept Anesthesia & Intens Care, Mondovi, Italy

[15] Osped Univ Padova, Anesthesia & Intens Care Unit, Padua, Italy

[16] Humanitas Clin & Res Ctr IRCCS, Milan, Italy

[17] Univ Padua, Dept Med DIMED, Padua, Italy

来源：

SCIENTIFIC REPORTS | 2021年 / 11卷 / 01期

关键词：

RESPIRATORY-FAILURE; INTENSIVE-CARE;

D O I：

10.1038/s41598-021-92960-z

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6-11] days in early extubated patients versus 11 [6-15] days in standard weaning group (p=0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p=0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p=0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.

引用

页数：9

共 25 条

[1]

Adults B. G., 2016, VENTILATORY MANAGEME, V71, P4

[2] Managing ICU surge during the COVID-19 crisis: rapid guidelines [J].

Aziz, Shadman ;

Arabi, Yaseen M. ;

Alhazzani, Waleed ;

Evans, Laura ;

Citerio, Giuseppe ;

Fischkoff, Katherine ;

Salluh, Jorge ;

Meyfroidt, Geert ;

Alshamsi, Fayez ;

Oczkowski, Simon ;

Azoulay, Elie ;

Price, Amy ;

Burry, Lisa ;

Dzierba, Amy ;

Benintende, Andrew ;

Morgan, Jill ;

Grasselli, Giacomo ;

Rhodes, Andrew ;

Moller, Morten H. ;

Chu, Larry ;

Schwedhelm, Shelly ;

Lowe, John J. ;

Bin, Du ;

Christian, Michael D. .

INTENSIVE CARE MEDICINE, 2020, 46 (07) :1303-1325

[3] Weaning from mechanical ventilation [J].

Boles, J-M. ;

Bion, J. ;

Connors, A. ;

Herridge, M. ;

Marsh, B. ;

Melot, C. ;

Pearl, R. ;

Silverman, H. ;

Stanchina, M. ;

Vieillard-Baron, A. ;

Welte, T. .

EUROPEAN RESPIRATORY JOURNAL, 2007, 29 (05) :1033-1056

[4] Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure [J].

Burns, Karen E. A. ;

Meade, Maureen O. ;

Premji, Azra ;

Adhikari, Neill K. J. .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (12)

[5] Critical Care Surge Capacity to Respond to the COVID-19 Pandemic in Italy: A Rapid and Affordable Solution in the Novara Hospital [J].

Cammarota, Gianmaria ;

Ragazzoni, Luca ;

Capuzzi, Fabio ;

Pulvirenti, Simone ;

De Vita, Nello ;

Santangelo, Erminio ;

Verdina, Federico ;

Grossi, Francesca ;

Vaschetto, Rosanna ;

Della Corte, Francesco .

PREHOSPITAL AND DISASTER MEDICINE, 2020, 35 (04) :431-433

[6] Evolution of Mortality over Time in Patients Receiving Mechanical Ventilation [J].

Esteban, Andres ;

Frutos-Vivar, Fernando ;

Muriel, Alfonso ;

Ferguson, Niall D. ;

Penuelas, Oscar ;

Abraira, Victor ;

Raymondos, Konstantinos ;

Rios, Fernando ;

Nin, Nicolas ;

Apezteguia, Carlos ;

Violi, Damian A. ;

Thille, Arnaud W. ;

Brochard, Laurent ;

Gonzalez, Marco ;

Villagomez, Asisclo J. ;

Hurtado, Javier ;

Davies, Andrew R. ;

Du, Bin ;

Maggiore, Salvatore M. ;

Pelosi, Paolo ;

Soto, Luis ;

Tomicic, Vinko ;

D'Empaire, Gabriel ;

Matamis, Dimitrios ;

Abroug, Fekri ;

Moreno, Rui P. ;

Soares, Marco Antonio ;

Arabi, Yaseen ;

Sandi, Freddy ;

Jibaja, Manuel ;

Amin, Pravin ;

Koh, Younsuck ;

Kuiper, Michael A. ;

Bulow, Hans-Henrik ;

Zeggwagh, Amine Ali ;

Anzueto, Antonio .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2013, 188 (02) :220-230

[7] COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? [J].

Fan, Eddy ;

Beitler, Jeremy R. ;

Brochard, Laurent ;

Calfee, Carolyn S. ;

Ferguson, Niall D. ;

Slutsky, Arthur S. ;

Brodie, Daniel .

LANCET RESPIRATORY MEDICINE, 2020, 8 (08) :816-821

[8] Management of COVID-19 Respiratory Distress [J].

Marini, John J. ;

Gattinoni, Luciano .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2020, 323 (22) :2329-2330

[9] Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients [J].

Nava, S ;

Gregoretti, C ;

Fanfulla, F ;

Squadrone, E ;

Grassi, M ;

Carlucci, A ;

Beltrame, F ;

Navalesi, P .

CRITICAL CARE MEDICINE, 2005, 33 (11) :2465-2470

[10]

Nava S, 2009, MINERVA ANESTESIOL, V75, P31

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