Strategies to Avoid Extubation Failure Among ICU Patients —Reply

In Reply Our clinical trial demonstrated that NIV alternating with high-flow nasal oxygen between NIV sessions applied after extubation of at-risk patients in the intensive care unit (ICU) significantly decreased reintubation rates compared with high-flow nasal oxygen alone. We agree with Dr Matsuda that NIV is a burden and that, consequently, this strategy must be well-justified before changing clinical practice. The trial was performed in 30 French ICUs and all centers had NIV experience, with a ratio of 2 nurses for 5 patients, and usually without a respiratory therapist. Although the protocol planned to apply NIV for a minimum period of 48 hours after extubation, in 23.2% of patients (149/641), the treatment was stopped and patients discharged from the ICU before 48 hours had elapsed. Conversely, NIV was continued beyond 48 hours in 25.4% of patients (86/339) because of incomplete recovery of respiratory status. Therefore, to reduce work overload, NIV might be applied for less than 48 hours according to patient respiratory status.
Source: JAMA - Category: General Medicine Source Type: research