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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Noninvasive positive-pressure ventilation for respiratory failure after extubation
New England Journal of Medicine, Volume 350, No. 24, Year 2004
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Description
BACKGROUND: The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive-pressure ventilation has been suggested as a promising therapy for patients with respiratory failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting. METHODS: Patients in 37 centers in eight countries who were electively extubated after at least 48 hours of mechanical ventilation and who had respiratory failure within the subsequent 48 hours were randomly assigned to either noninvasive positive-pressure ventilation by face mask or standard medical therapy. RESULTS A total of 221 patients with similar baseline characteristics had been randomly assigned to either noninvasive ventilation (114 patients) or standard medical therapy (107 patients) when the trial was stopped early, after an interim analysis. There was no difference between the noninvasive-ventilation group and the standard-therapy group in the need for reintubation (rate of reintubation, 48 percent in both groups; relative risk in the noninvasive-ventilation group, 0.99; 95 percent confidence interval, 0.76 to 1.30). The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the standard-therapy group (25 percent vs. 14 percent; relative risk, 1.78; 95 percent confidence interval, 1.03 to 3.20; P=0.048), and the median time from respiratory failure to reintubation was longer in the noninvasive-ventilation group (12 hours vs. 2 hours 30 minutes, P=0.02). CONCLUSIONS: Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have respiratory failure after extubation. Copyright © 2004 Massachusetts Medical Society.
Authors & Co-Authors
Esteban, Andrés
Spain, Getafe
Hospital Universitario de Getafe
Frutos-Vivar, Fernando
Spain, Getafe
Hospital Universitario de Getafe
Ferguson, Niall D.
Spain, Getafe
Hospital Universitario de Getafe
Canada, Toronto
University of Toronto
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Fahad National Guard Hospital
Apezteguía, Carlos J.
Argentina, Buenos Aires
Hospital Profesor Posadas
González, Marco A.
Colombia, Medellin
Hospital General de Medellin Luz Castro de Gutiérrez - E.s.e
Epstein, Scott K.
United States, Boston
Tufts University School of Medicine
Hill, Nicholas S.
United States, Boston
Tufts University School of Medicine
Nava, Stefano
Italy, Pavia
Istituti Clinici Scientifici Maugeri Spa – sb
Soares, Marco Antonio
Brazil, Belo Horizonte
Hospital Universitário São José
D'Empaire, Gabriel
Venezuela, Caracas
Hospital de Clínicas Caracas
Alia, Inmaculada Moreno
Spain, Getafe
Hospital Universitario de Getafe
Anzueto, Antonio R.
United States, San Antonio
University of Texas Health Science Center at San Antonio
Statistics
Citations: 770
Authors: 13
Affiliations: 10
Identifiers
Doi:
10.1056/NEJMoa032736
ISSN:
00284793