Abstract
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.
Highlights
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 invasive mechanical ventilation (IMV) duration, extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality
Early extubation followed by immediate Non-invasive ventilation (NIV), in patients still dependent on relatively high level of positive end-expiratory pressure and inspiratory assistance, has been safely and effectively used in selected patients recovering from hypoxemic ARF, with a reduction of IMV duration and hospital length of stay, and a decrease of pulmonary infections, compared to standard weaning through the endotracheal tube[10,11]
In this retrospective multicenter observational study, we compared early extubation followed by immediate NIV and standard weaning with respect to duration of IMV, rate of extubation failure, reintubation, and tracheostomy, intensive care unit (ICU) mortality, and length of stay
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). Early extubation followed by immediate NIV might be useful in intubated COVID-19 patients with ARF In this retrospective multicenter observational study, we compared early extubation followed by immediate NIV and standard weaning with respect to duration of IMV (primary endpoint), rate of extubation failure, reintubation, and tracheostomy, intensive care unit (ICU) mortality, and length of stay (additional endpoints)
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