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

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

Abstract 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...

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Autores principales: Gianmaria Cammarota, Rosanna Vaschetto, Danila Azzolina, Nello De Vita, Carlo Olivieri, Chiara Ronco, Federico Longhini, Andrea Bruni, Davide Colombo, Claudio Pissaia, Federico Prato, Carlo Maestrone, Matteo Maestrone, Luigi Vetrugno, Tiziana Bove, Francesco Lemut, Elisa Taretto, Alessandro Locatelli, Nicoletta Barzaghi, Martina Cerrano, Enrico Ravera, Christian Zanza, Andrea Della Selva, Ilaria Blangetti, Francesco Salvo, Fabrizio Racca, Yaroslava Longhitano, Annalisa Boscolo, Ilaria Sguazzotti, Valeria Bonato, Francesca Grossi, Federico Crimaldi, Raffaella Perucca, Ester Boniolo, Federico Verdina, Gian Luca Vignazia, Erminio Santangelo, Riccardo Tarquini, Marta Zanoni, Antonio Messina, Matteo Marin, Paola Bacigalupo, Graziana Sileci, Nicolò Sella, Edardo De Robertis, Francesco Della Corte, Paolo Navalesi
Formato: article
Lenguaje:EN
Publicado: Nature Portfolio 2021
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Medicine
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Science
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Acceso en línea:https://doaj.org/article/f52f0ee4ddb841aca78990eefd039688
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Sumario:Abstract 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.

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