Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit

Ghosh, Supradip; Chawla, Aayush; Jhalani, Ranupriya; Salhotra, Ripenmeet; Arora, Garima; Nagar, Satyanarayan; Bhadauria, Abhay S; Mishra, Kirtee; Singh, Amandeep; Lyall, Aditya

doi:10.5005/jp-journals-10071-23673

Cited by 4 publications

(10 citation statements)

References 25 publications

(9 reference statements)

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“…Part of these data were reported in two earlier publications. 6 , 10 Institutional ethics committee approval was obtained for both studies and consents of patients’ relatives were obtained before enrolment. Inclusion criteria for study entry were consenting adult (>18 years) patients who had planned extubation following invasive ventilation for at least 24 hours and who were put on NIV support postextubation for any one of the following high-risk criteria: underlying chronic obstructive airway disease (COAD) with PaCO 2 >45 mm Hg at extubation, age >65 years, history of chronic heart failure (New York Heart Association class II-IV) or left ventricular ejection fraction <40%, prior failed spontaneous breathing trial or two or more organ system failure other than chronic respiratory or heart failure.…”

Section: Ethodsmentioning

confidence: 99%

“…Protocol for NIV application has been published previously. 6 Initially NIV support was applied almost continuously for 6 to 12 hours except for 15 to 20 minutes periods to allow the patient to drink fluids or receive nursing care. Unassisted periods of breathing were allowed for a gradually increasing period following initial 6 to 12 hours of NIV support; provided the patient was comfortable and was able to maintain adequate oxygenation and pH remained >7.35.…”

Section: Ethodsmentioning

confidence: 99%

“…The data collection process was uniform and was described in our previous publication. 6 All relevant data were collected both at intubation and at the time of extubation. Time to reintubation (from the time of extubation) and indications for reintubation were recorded for patients requiring reintubation.…”

Section: Ethodsmentioning

confidence: 99%

“… 5 To complicate the matter further, failure of prophylactic NIV is demonstrated to be associated with worsening of organ dysfunction, more adverse events, and an increase in-hospital mortality. 6 More recently, high flow nasal oxygenation (HFNO) is gaining popularity as postextubation respiratory support with noninferiority of HFNO (vs NIV) demonstrated in preventing postextubation respiratory failure. 7 , 8 Combining HFNO and NIV is found to be even better than HFNO alone.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Ghosh

Singh

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Introduction With emerging evidence supporting other interventions, there is a need to re-examine the safety and efficacy of postextubation noninvasive ventilation (NIV) support in high-risk patients. Methods Data were collected over 4-year period from a multispeciality ICU. High-risk criteria were uniform, and the application of NIV was protocolized. Successful extubation was defined as the absence of both reintubation and NIV support at 72 hours postextubation. Results Extubation success was achieved in 79.6%. At extubation, more patients in the failure group had chronic neurological or kidney diseases, longer days of invasive ventilation, higher sequential organ failure assessment score, and more positive fluid balance. Significant differences were also observed in the indications for prophylactic NIV between the two groups. However, in logistic regression analysis, none of these differences observed in univariate analysis was independently associated with extubation outcome. Failure of postextubation NIV was associated with higher hospital mortality (67.7 vs 10.7%, p <0.001) and longer ICU/hospital length of stay (median 10 vs 6 days, p <0.001 and 13 vs 10 days, p <0.01, respectively). No differences were observed in extubation outcomes between 2016 to 2017 and 2018 to 2019 cohorts. Conclusion High rate of extubation failure and worse patient-centric outcomes associated with prophylactic NIV calls for a relook into the current recommendation of NIV for this indication. How to cite this article Ghosh S, Ghosh S, Singh A, Salhotra R. Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU. Indian J Crit Care Med 2021;25(6):709–714.

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Section: Ethodsmentioning

confidence: 99%

Section: Ethodsmentioning

confidence: 99%

Section: Ethodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Ghosh

Singh

et al. 2021

Indian Journal of Critical Care Medicine

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“…Extubation is considered when the endolaryngeal prosthesis is removed without the need for reintubation within the next 48 hours or within seven days 15 . The extubation failure rate increases when the success assessment time is taken into account and is between 12.5%, 15.3% and 22% in patients assessed at 24 hours, 72 hours and more than 72 hours respectively, being 26% the mean rate assessed 48 hours after extubation 16 .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with extubation failure in an intensive care unit: a case-control study

Arcanjo

Beccária

2023

Rev. Latino-Am. Enfermagem

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Objective: to investigate the factors associated with extubation failure of patients in the intensive care unit. Method: unpaired, longitudinal, retrospective and quantitative case-control with the participation of 480 patients through clinical parameters for ventilator weaning. Data were analyzed by: Fisher’s exact test or the chi-square test; unpaired two-tailed Student’s t test; and Mann-Whitney test. Significant P values lower than or equal to 0.05 were admitted. Results: of the patients, 415 (86.5%) were successful and 65 (13.5%) failed. Success group: the most negative fluid balance, APACHE II in 20 (14-25), weak cough in 58 (13.9%). Failure group: the most positive fluid balance, APACHE II in 23 (19-29), weak cough in 31 (47.7%), abundant amount of pulmonary secretions in 47.7%. Conclusion: positive fluid balance and the presence of inefficient cough or inability to clear the airway were predictors of extubation failure.

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Factores asociados al fracaso de la extubación en unidad de cuidados intensivos: estudio de caso y control

Arcanjo

Beccária

2023

Rev. Latino-Am. Enfermagem

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Resumen Objetivo: investigar los factores asociados al fracaso de la extubación de pacientes en la unidad de cuidados intensivos. Método: caso y control no apareado, longitudinal, retrospectivo y cuantitativo con la participación de 480 pacientes mediante parámetros clínicos para el destete de la ventilación. Datos analizados por: Prueba Exacta de Fisher o prueba de Chi-cuadrado; prueba t de Student de dos colas para datos no apareados; y prueba de Mann-Whitney. Se admitieron valores de P significativos menores o iguales a 0,05. Resultados: de los pacientes, 415 (86,5%) tuvieron éxito y 65 (13,5%) fracasaron. Grupo de éxito: balance hídrico más negativo, APACHE II en 20 (14-25), tos débil en 58 (13,9%). Grupo de fracaso: balance de líquidos más positivo, APACHE II en 23 (19-29), tos débil en 31 (47,7%), abundante cantidad de secreciones pulmonares en 47,7%. Conclusión: el balance hídrico positivo y la presencia de tos ineficaz o incapacidad para higienizar la vía aérea fueron predictores de fracaso de la extubación.

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Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit

Cited by 4 publications

References 25 publications

Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Factors associated with extubation failure in an intensive care unit: a case-control study

Factores asociados al fracaso de la extubación en unidad de cuidados intensivos: estudio de caso y control

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