RT Journal Article SR Electronic T1 Effect of Sequential Noninvasive Ventilation on Early Extubation After Acute Type A Aortic Dissection JF Respiratory Care FD American Association for Respiratory Care SP 1160 OP 1167 DO 10.4187/respcare.07522 VO 65 IS 8 A1 Kai Liu A1 Guang-Wei Hao A1 Ji-Li Zheng A1 Jing-Chao Luo A1 Ying Su A1 Jun-Yi Hou A1 Guo-Guang Ma A1 Shen-Ji Yu A1 Jun Li A1 Yong-Xin Sun A1 Hao Lai A1 Chun-Sheng Wang A1 Zhe Luo A1 Guo-Wei Tu YR 2020 UL http://rc.rcjournal.com/content/65/8/1160.abstract AB BACKGROUND: Acute type A aortic dissection (aTAAD) is associated with a high incidence of prolonged postoperative invasive mechanical ventilation. We aimed to assess whether sequential noninvasive ventilation (NIV) could facilitate early extubation postoperatively after a spontaneous breathing trial (SBT) failure among aTAAD patients.METHODS: Beginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extubation concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The primary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation.RESULTS: During the study period, 78 subjects with aTAAD failed their first postoperative SBT (38 subjects in phase 1 and 40 subjects in phase 2). Subjects extubated with sequential NIV had shorter median (interquartile range [IQR]) duration of invasive ventilation of 39.5 (30.8–57.8) h vs 89.5 (64–112) h (P < .001) and median (IQR) length of ICU stay of 6 (4.0–7.8) d vs 7.5 (5.8–9.0) d (P = .030). There were no significant differences between the 2 phases with regard to rates of re-intubation (7.5% vs 7.89%, P = .95), tracheostomy (2.5% vs 5.26%, P = .53), and in-hospital mortality (2.5% vs 2.63%, P = .97).CONCLUSIONS: Early extubation followed by sequential NIV significantly reduced duration of invasive ventilation and length of ICU stay without increasing re-intubation rate in postoperative subjects with aTAAD who failed their first SBT.