The following is a summary of “Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial,” published in the November 2024 issue of Critical Care by Rouby et al. 

Researchers conducted a retrospective study to evaluate whether noninvasive ventilation (NIV) combined with high-flow nasal oxygen (HFNO) reduced postextubation respiratory failure (PRF).    

They included individuals on ventilation without chronic obstructive pulmonary disease (COPD) and at high risk of PRF based on a lung ultrasound score (LUS) ≥ 14 during the spontaneous breathing trial, PRF was defined by at least 2 criteria: SpO₂ < 90%, respiratory rate > 30/min, hypercapnia, or respiratory-related haemodynamic/neurological issues. The intervention group received prophylactic NIV alternating with HFNO for 48 hours post-extubation, while the control group received conventional oxygen. The clinicians were aware of LUS in the intervention group but blinded in the control group. The primary outcome was PRF incidence within 48 hours, with secondary outcomes including PRF and reintubation at day 7, ventilator-free days at day 28, ICU length of stay, and mortality at days 28 and 90.  

The results showed 240 individuals were randomized, with 227 analyzed (intervention group = 128; control group = 99). The PRF at 48 hours was lower in the intervention group compared to the control, with a relative risk of 0.52 (0.31 to 0.88), P = 0.01. This benefit persisted on day 7, with a relative risk of 0.62 (0.44 to 0.96), P = 0.02. The reconnection to mechanical ventilation was not significantly reduced and rescue NIV prevented reintubation in 44% of control and 12% of intervention participants (P = 0.008). No differences were observed in other secondary outcomes. Prophylactic NIV alternating with HFNO was resource-intensive and costly compared to conventional oxygen with rescue NIV.  

Investigators concluded the prophylactic NIV alternating with HFNO significantly reduced PRF but did not decrease reintubation or mortality rates, showing similar efficacy to rescue NIV in managing respiratory failure. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05166-w