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

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 (SB...

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Published in:	Scientific reports Vol. 11; no. 1; p. 13418
Main Authors:	Cammarota, Gianmaria, Vaschetto, Rosanna, Azzolina, Danila, De Vita, Nello, Olivieri, Carlo, Ronco, Chiara, Longhini, Federico, Bruni, Andrea, Colombo, Davide, Pissaia, Claudio, Prato, Federico, Maestrone, Carlo, Maestrone, Matteo, Vetrugno, Luigi, Bove, Tiziana, Lemut, Francesco, Taretto, Elisa, Locatelli, Alessandro, Barzaghi, Nicoletta, Cerrano, Martina, Ravera, Enrico, Zanza, Christian, Selva, Andrea Della, Blangetti, Ilaria, Salvo, Francesco, Racca, Fabrizio, Longhitano, Yaroslava, Boscolo, Annalisa, Sguazzotti, Ilaria, Bonato, Valeria, Grossi, Francesca, Crimaldi, Federico, Perucca, Raffaella, Boniolo, Ester, Verdina, Federico, Vignazia, Gian Luca, Santangelo, Erminio, Tarquini, Riccardo, Zanoni, Marta, Messina, Antonio, Marin, Matteo, Bacigalupo, Paola, Sileci, Graziana, Sella, Nicolò, De Robertis, Edardo, Corte, Francesco Della, Navalesi, Paolo
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 28-06-2021 Nature Publishing Group Nature Portfolio
Subjects:	692/699/1785/3193 692/699/255/2514 Coronaviruses COVID-19 Extubation Humanities and Social Sciences Length of stay Mechanical ventilation Mortality multidisciplinary Ostomy Oxygen therapy Respiratory failure Science Science (multidisciplinary) Tracheostomy Tracheotomy Ventilation Ventilators Weaning
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2045-2322 2045-2322
DOI:	10.1038/s41598-021-92960-z