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Publications

Journal Article Ahead of print

PubMed: 41973108 DOI: 10.1007/s00134-026-08396-4

Prophylactic noninvasive ventilation after extubation in high-risk patients without hypercapnia.

Intensive Care Med

Authors: Arnaud W Thille, Louis Chamblet, Stéphanie Ragot, Arnaud Gacouin, Mai-Anh Nay, Stephan Ehrmann, Christophe Girault, Laurence Dangers, Guylaine Labro, Emmanuel Canet, Jean-Pierre Quenot, Maxens Decavele, Christophe Guitton, Gwenael Prat, Clément Saccheri, Damien Contou, Anahita Rouze, Marie-Ange Azais, Antoine Romen, Guillaume Lacave, Alexandre Lautrette, Nicholas Sedillot, Romain Sonneville, Emmanuel Vivier, Marie-Anne Hoppe, Jeremy Bourenne, François Beloncle, Rémi Coudroy, Jean-Pierre Frat

Affiliations

  • CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
  • CHU de Poitiers, INSERM CIC 1402 IS-ALIVE, Université de Poitiers, Poitiers, France.
  • CHU de Poitiers, INSERM CIC 1402 IS-ALIVE, Université de Poitiers, Poitiers, France.
  • CHU de Rennes, Hôpital Ponchaillou, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France.
  • CHU d'Orléans, Médecine Intensive Réanimation, Orléans, France.
  • CHU de Tours, Médecine Intensive Réanimation, Tours, France.
  • CIC INSERM 1415, Université de Tours, Tours, France.
  • CRICS-TriggerSEP F-CRIN Research Network, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France.
  • CHU de Rouen, Médecine Intensive Réanimation, Normandie Univ, UNIROUEN, GRHVN UR 3830, Rouen, France.
  • CHU Félix Guyon, Service de Réanimation Polyvalente, Saint Denis de la Réunion, France.
  • Groupement Hospitalier Régional Mulhouse et Sud Alsace, Service de Médecine Intensive Réanimation, Mulhouse, France.
  • CHU de Nantes, Médecine Intensive Réanimation, Nantes, France.
  • Université Bourgogne-Europe, CHU Dijon-Bourgogne, Service de Médecine Intensive-Réanimation, INSERM CIC-1432-Equipe Lipness UMR 1231, Dijon, France.
  • Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation (Département R3S), Paris, France.
  • Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
  • CH Le Mans, Médecine Intensive Réanimation, Le Mans, France.
  • CHU de Brest, Médecine Intensive Réanimation, Brest, France.
  • CHU de Nice, Médecine Intensive Ranimation, Nice, France.
  • CH d'Argenteuil, Médecine Intensive Réanimation, Argenteuil, France.
  • Université de Lille, CNRS, INSERM, CHU Lille, U1285-UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive Réanimation, Lille, France.
  • CH Départemental de Vendée, Médecine Intensive Réanimation, La Roche-Sur-Yon, France.
  • CH de Pau, Service de Réanimation, Pau, France.
  • CH de Versailles, Médecine Intensive Réanimation, Le Chesnay, France.
  • CHU de Clermont-Ferrand, Médecine Intensive Réanimation, Clermont-Ferrand, France.
  • CH de Bourg-en-Bresse, Médecine Intensive Réanimation, Bourg-en-Bresse, France.
  • AP-HP, Hôpital Bichat, Médecine Intensive Réanimation, Paris, France.
  • Hôpital Saint Joseph-Saint Luc, Service de Réanimation, Lyon, France.
  • CH de La Rochelle, Médecine Intensive Réanimation, La Rochelle, France.
  • AP-HM, CHU La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, Marseille, France.
  • CHU d'Angers, Médecine Intensive Réanimation, Angers, France.
  • CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.

Abstract

PURPOSE

The beneficial effects of prophylactic noninvasive ventilation (NIV) after extubation in patients without hypercapnia are uncertain. Our objective was to assess the effects of prophylactic NIV on reintubation among patients without hypercapnia at the time of extubation.

METHODS

Post hoc analysis of two multicenter clinical trials including high-risk patients (i.e., patients older than 65 years or with underlying cardiac/respiratory disease). Our analysis focused on the 829 patients without hypercapnia (PaCO 2 ≤ 45 mmHg), the day of extubation who received NIV alternating high-flow nasal cannula (HFNC) oxygen or HFNC alone after extubation. The primary outcome was the proportion of patients who required reintubation within seven days following extubation. We used G-computation to robustly estimate the marginal causal effect of treatment on the risk of reintubation.

RESULTS

After extubation, 540 patients (65%) received NIV + HFNC while 289 (35%) received HFNC alone. The reintubation rate at day 7 was 11.8% [95% CI 9.4-14.8%] with NIV + HFNC versus 17.6% [95% CI 13.7-22.5%] with HFNC alone (difference, - 5.8% [95% CI - 11.2 to -0.8%]; p = 0.021). Using G-computation, NIV + HFNC was more effective than HFNC alone in reducing the risk of reintubation, with an estimated difference of - 5.6% [95% CI - 11.0 to - 0.5%]. Reintubation rates were also significantly lower with NIV + HFNC than with HFNC alone at 48 h, 72 h, and until ICU discharge.

CONCLUSION

For high-risk patients, but without hypercapnia on the day of extubation, the use of prophylactic NIV alternating with HFNC after extubation significantly decreases the risk of reintubation as compared to HFNC alone.

MeSH

Noninvasive Ventilation, Critical Care, Intensive Care Units, Ventilation, Cannula, Hypercapnia