Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery: A Randomized Clinical Trial

This article was published in JAMA 5th April 2016 v315 n13 p1345-53 by the NIVAS Study Group is described below.  This issue of JAMA is available in the Healthcare Library on D Level of Rotherham Hospital.

It has not been established whether non-invasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery. This research evaluated whether non-invasive ventilation improves outcomes among patients developing hypoxemic acute respiratory failure after abdominal surgery.

Multi-centre, randomized, parallel-group clinical trial conducted between May 2013 and September 2014 in 20 French intensive care units among 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure.  Patients were randomly assigned to receive standard oxygen therapy (up to 15 L/min to maintain SpO2 of 94% or higher) (n = 145) or NIV delivered via facial mask (inspiratory pressure support level, 5-15 cm H2O; positive end-expiratory pressure, 5-10 cm H2O; fraction of inspired oxygen titrated to maintain SpO2 ≥94%) (n = 148).

The primary outcome was tracheal reintubation for any cause within 7 days of randomization. Secondary outcomes were gas exchange, invasive ventilation-free days at day 30, health care-associated infections, and 90-day mortality. Among the 293 patients included in the intention-to-treat analysis, reintubation occurred in 33.1% in the NIV group and in 45.5% in the standard oxygen therapy group.  Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days), while fewer patients developed health care-associated infections (31.4% vs 49.2%).  At 90 days, 14.9% in the NIV group and 21.5% in the standard oxygen therapy group had died. There were no significant differences in gas exchange.

Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting.

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