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- W4376637575 abstract "Rationale: Non-invasive respiratory support using high flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV) can decrease the risk of reintubation in patients being liberated from mechanical ventilation, but effects in patients with acute brain injury are unknown. Objectives: To evaluate the association between post-extubation non-invasive respiratory support and reintubation in patients with acute brain injury being liberated from mechanical ventilation. Methods: This was a secondary analysis of a prospective, observational study of mechanically ventilated patients with acute brain injury (NCT 03400904). The primary endpoint was reintubation during ICU admission. We used mixed effects logistic regression models with patient-level covariates and random intercepts for hospital and country to evaluate the association between prophylactic (i.e, planned) HFNC or NIPPV and reintubation. Measurements and Main Results: 1,115 patients were included from 62 hospitals and 19 countries, of whom 267 received HFNC or NIPPV following extubation (23.9%). Compared to conventional oxygen therapy, neither prophylactic HFNC nor NIPPV was associated with decreased risk of reintubation (respectively, odds ratio (OR), 0.97; 95% confidence interval (CI), 0.54–1.73; OR, 0.63; 95%CI, 0.30–1.32). Findings remained consistent in sensitivity analyses accounting for alternate adjustment procedures, missing data, shorter timeframes of extubation failure, and competing risks precluding reintubation. In a Bayesian analysis using skeptical and data-driven priors, the probability of reduced reintubation ranged from 17-34% for HFNC and 46-74% for NIPPV. Conclusions: In a large cohort of brain-injured patients undergoing liberation from mechanical ventilation, prophylactic use of HFNC and NIPPV were not associated with reintubation. Prospective trials are needed to explore treatment effects in this population." @default.
- W4376637575 created "2023-05-17" @default.
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- W4376637575 date "2023-08-01" @default.
- W4376637575 modified "2023-10-17" @default.
- W4376637575 title "Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study" @default.
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- W4376637575 doi "https://doi.org/10.1164/rccm.202212-2249oc" @default.
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