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Research ArticleOriginal Research

Effect of Noninvasive Ventilation After Unplanned Extubation

Agathe Kudela, Maude Millereux, Corentin Gouezel, Dominique Prat, Frédéric Jacobs, Olfa Hamzaoui, Nadège Demars, Guy Moneger, Anne Sylvie Dumenil, Pierre Trouiller and Benjamin Sztrymf
Respiratory Care November 2018, respcare.06328; DOI: https://doi.org/10.4187/respcare.06328
Agathe Kudela
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Maude Millereux
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Corentin Gouezel
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Dominique Prat
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Frédéric Jacobs
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Olfa Hamzaoui
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Nadège Demars
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Guy Moneger
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Anne Sylvie Dumenil
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Pierre Trouiller
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.
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Benjamin Sztrymf
Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.Institut National de la Santé et de la Recherche Médicale U999, Centre Chirurgical Marie Lannelongue, Université Paris Sud, Le Plessis Robinson, France.
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  • For correspondence: benjamin.sztrymf@aphp.fr
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Abstract

BACKGROUND: Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation.

METHODS: Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis.

RESULTS: A total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3–73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36–54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV, n = 10; rescue NIV, n = 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5–49.2] vs 0.46 [0.25–1] h, P = .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7–24.5] vs 6 [3–14] d, respectively, P = .004; and 9 [3–22] vs 3 [1–7.3] d, respectively, P = .003).

CONCLUSIONS: NIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure.

  • unplanned extubation
  • noninvasive ventilation
  • re-intubation
  • outcome
  • ICU
  • prophylaxis

Footnotes

  • Correspondence: Benjamin Sztrymf MD PhD, Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, France. E-mail: benjamin.sztrymf{at}aphp.fr.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2018 by Daedalus Enterprises
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Respiratory Care: 64 (12)
Respiratory Care
Vol. 64, Issue 12
1 Dec 2019
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Effect of Noninvasive Ventilation After Unplanned Extubation
Agathe Kudela, Maude Millereux, Corentin Gouezel, Dominique Prat, Frédéric Jacobs, Olfa Hamzaoui, Nadège Demars, Guy Moneger, Anne Sylvie Dumenil, Pierre Trouiller, Benjamin Sztrymf
Respiratory Care Nov 2018, respcare.06328; DOI: 10.4187/respcare.06328

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Effect of Noninvasive Ventilation After Unplanned Extubation
Agathe Kudela, Maude Millereux, Corentin Gouezel, Dominique Prat, Frédéric Jacobs, Olfa Hamzaoui, Nadège Demars, Guy Moneger, Anne Sylvie Dumenil, Pierre Trouiller, Benjamin Sztrymf
Respiratory Care Nov 2018, respcare.06328; DOI: 10.4187/respcare.06328
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Keywords

  • unplanned extubation
  • noninvasive ventilation
  • re-intubation
  • outcome
  • ICU
  • prophylaxis

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