Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Thanthitaweewat,; Muntham, Dittapol; Chirakalwasan, Naricha

doi:10.4103/ijccm.ijccm_236_18

Cited by 12 publications

(16 citation statements)

References 33 publications

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“…Unfortunately researches on ICU patients are scarce. Nowadays different ICUs have been set up including medical, [1] surgical, [2] cardiac, [3] neonatal, [4] open and closed ICUs. Admissions in ICUs have considerately increased during the recent years.…”

Section: Introductionmentioning

confidence: 99%

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Yang

Feng

2019

Medicine

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Background: Nowadays most of the intensive care units (ICUs) operate as a closed format in comparison to an open format. The new concept of a closed ICU is where patients are admitted under the full responsibility of a trained intensivist, whereas an open ICU is where patients are admitted under the care of another attending physician and intensivists are just available for consultation. In this analysis, we aimed to systematically compare mortality rate and other clinical features observed in open vs closed ICU formats. Methods: Biomedical and pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central and www.ClinicalTrials.gov were searched for required English publications. Mortality, the frequency of patients requiring mechanical ventilation, central line, arterial line and pulmonary arterial catheter were assessed respectively. Statistical analysis was carried out by the RevMan software. Odds ratios (OR) with 95% confidence intervals (CIs) were used to represent the data following analysis. Results: Five studies with a total number of 6160 participants enrolled between years 1992 to 2007 were included. Results of this analysis showed that mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 1.17–1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 1.09–1.59; P = .005) (using a random effect model). Closed format ICUs were associated with significantly higher number of patients that required central line (OR: 0.56, 95% CI: 0.34–0.92; P = .02). Patients requiring mechanical ventilation (OR: 1.08, 95% CI: 0.65–1.78; P = .77), patients requiring arterial line (OR: 1.05, 95% CI: 0.49–2.29; P = .89) and patients requiring pulmonary arterial catheter (OR: 0.86, 95% CI: 0.40–1.87; P = .71) were similar in the open vs the closed setting. Conclusion: This analysis showed that mortality rate was significantly higher in an open as compared to a closed format ICU. However, the frequency of patients requiring mechanical ventilation, arterial line and pulmonary arterial catheter was similarly observed. Larger trials are expected to further confirm those hypotheses.

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Section: Introductionmentioning

confidence: 99%

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Yang

Feng

2019

Medicine

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“…Respiratory failure HFNC: 67 (12) COT: 70 (13) NA AHRF HFNC: 8.2 (5.9) COT: 7.4 (3.6) Song et al [ 37 ] Published 60 HFNC COT 1. Reintubation HFNC: 66 (14) COT 71 (13) NA Pneumonia [41.7%] HFNC: 5.5 (3.4) COT: 5.4 (2.8) Thanthitaweewat et al [ 34 ] Published 58 NPPV COT 1. Mortality (28 days) 2.…”

Section: Resultsmentioning

confidence: 99%

Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

et al. 2021

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Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

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“…Network meta-analysis methods were used to comparatively investigate the three groups. The estimate of network effects for short-term mortality was as follows: compared to COT, NHFT yielded an RD of 12 fewer per 1000 (95%CI: 32 fewer to 16 more) (4 RCTs, n = 802) [ 483 – 486 ], NIV yielded an RD of 31 fewer per 1000 (95%CI: 53 fewer to 1 more) (5 RCTs, n = 784) [ 487 – 491 ]. When compared to NHFT, NIV yielded an RD of 43 fewer per 1000 (95%CI: 102 fewer to 32 more) (1 RCT, n = 604) [ 492 ].…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

“…When compared to NHFT, NIV yielded an RD of 43 fewer per 1000 (95%CI: 102 fewer to 32 more) (1 RCT, n = 604) [ 492 ]. The estimate of network effects for the rate of re-intubation were as follows: compared to COT, NHFT yielded an RD of 69 fewer per 1000 (95%CI: 99 fewer to 12 fewer) (5 RCTs, n = 864) [ 483 – 486 , 493 ] and NIV yielded an RD of 66 fewer per 1000 (95%CI: 99 fewer to 1 fewer) (4 RCTs, n = 664) [ 487 – 489 , 491 ]. When compared to NHFT, NIV yielded an RD of 16 more per 1000 (95%CI: 109 fewer to 271 more) (1 RCT, n = 604) [ 492 ].…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

et al. 2021

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Cited by 12 publications

References 33 publications

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

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