{"id":464,"date":"2025-01-23T10:25:41","date_gmt":"2025-01-23T10:25:41","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=464"},"modified":"2025-01-23T11:14:58","modified_gmt":"2025-01-23T11:14:58","slug":"weaning-of-non-copd-patients-at-high-risk-of-extubation-failure-assessed-by-lung-ultrasound-the-win-in-wean-multicentre-randomised-controlled-trial","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/01\/23\/weaning-of-non-copd-patients-at-high-risk-of-extubation-failure-assessed-by-lung-ultrasound-the-win-in-wean-multicentre-randomised-controlled-trial\/","title":{"rendered":"Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial"},"content":{"rendered":"<h2 id=\"Abs1\" class=\"c-article-section__title js-section-title js-c-reading-companion-sections-item\">Abstract<\/h2>\n<div id=\"Abs1-content\" class=\"c-article-section__content\">\n<h3 class=\"c-article__sub-heading\" data-test=\"abstract-sub-heading\">Background<\/h3>\n<p>Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity\/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF.<\/p>\n<h3 class=\"c-article__sub-heading\" data-test=\"abstract-sub-heading\">Methods<\/h3>\n<p>Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS)\u2009\u2265\u200914 assessed during the spontaneous breathing trial, were included in a French-Chinese randomised controlled trial. PRF was defined by 2 among the following signs: SpO<sub>2<\/sub>\u2009&lt;\u200990%; Respiratory rate\u2009&gt;\u200930 \/min; hypercapnia; haemodynamic and\/or neurological disturbances of respiratory origin. In the intervention group, prophylactic NIV alternating with HFNO was administered for 48\u00a0h following extubation. In the control group, conventional oxygen was used. Clinicians were informed on the LUS in the intervention group, those in the control group remained blind. The primary outcome was the incidence of PRF 48\u00a0h after extubation. Secondary outcomes were incidence of PRF and reintubation at day 7, number of ventilator-free days at day 28, length of ICU stay and mortality at day 28 and 90.<\/p>\n<h3 class=\"c-article__sub-heading\" data-test=\"abstract-sub-heading\">Results<\/h3>\n<p>Two hundred and forty patients were randomised and 227 analysed (intervention group\u2009=\u2009128 and control group\u2009=\u200999). PRF at H48 was reduced in the intervention group compared to the control group: relative risk 0.52\u00a0(0.31 to 0.88),\u00a0<i>p<\/i>\u2009=\u20090.01. The benefit persisted at day 7: relative risk 0.62 (0.44 to 0.96),\u00a0<i>p<\/i>\u2009=\u20090.02. Weaning failure imposing reconnection to mechanical ventilation was not reduced. In patients who developed PRF and were treated by rescue NIV, reintubation was avoided in 44% of control patients and in 12% of intervention patients (<i>p<\/i>\u2009=\u20090.008). Other secondary outcomes were not different between groups. From a resource utilisation standpoint, prophylactic NIV alternating with HFNO was more demanding and costly than conventional oxygen with rescue NIV to achieve same clinical outcome.<\/p>\n<h3 class=\"c-article__sub-heading\" data-test=\"abstract-sub-heading\">Conclusions<\/h3>\n<p>Compared to conventional oxygenation, prophylactic NIV alternating with HFNO significantly reduced postextubation respiratory failure but failed to reduce reintubation rate and mortality in patients without COPD at high risk of extubation failure. Prophylactic NIV alternating with HFNO was as efficient as recue NIV to treat postextubation respiratory failure.<\/p>\n<blockquote><p><strong data-olk-copy-source=\"MessageBody\">Key Points<\/strong>:<\/p><\/blockquote>\n<ol>\n<li><strong>Study Population<\/strong>: Included 227 mechanically ventilated patients (LUS \u2265 14), randomized to either prophylactic NIV+HFNO or conventional oxygen.<\/li>\n<li><strong>Primary Outcome<\/strong>: Prophylactic NIV+HFNO reduced PRF incidence at 48 hours post extubation (19% vs. 28%, p = 0.01).<\/li>\n<li><strong>Secondary Outcomes<\/strong>: PRF incidence at 7 days was lower in the intervention group (30% vs. 38%, p = 0.02), but no differences were observed in reintubation rates, ICU mortality, or length of ICU stay.<\/li>\n<li><strong>Reintubation Rates<\/strong>: Similar reintubation rates were observed in both groups (22.2% vs. 24.2%, p = 0.72).<\/li>\n<li><strong>Lung Ultrasound Utility<\/strong>: LUS \u2265 14 identified patients at high risk for PRF, enabling targeted intervention.<\/li>\n<li><strong>Adverse Events<\/strong>: No significant differences in serious adverse events or respiratory discomfort between groups.<\/li>\n<li><strong>Resource Utilization<\/strong>: Prophylactic NIV+HFNO was more resource-intensive and costly than conventional oxygen with rescue NIV for comparable clinical outcomes.<\/li>\n<li><strong>Rescue NIV Effectiveness<\/strong>: Rescue NIV avoided reintubation in 44% of control patients with PRF, compared to 12% in the intervention group.<\/li>\n<li><strong>Guideline Implications<\/strong>: Findings challenge prior guidelines suggesting superiority of prophylactic NIV+HFNO over rescue NIV in this population.<\/li>\n<li><strong>Limitations<\/strong>: The study did not include COPD patients, limiting its applicability to this subgroup.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-024-05166-w\"><strong>ACCESS FULL ARTICLE HERE<\/strong><\/a><\/p>\n<p><b>Open Access<\/b>\u00a0This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article\u2019s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article\u2019s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit\u00a0<a href=\"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/\" rel=\"license\">http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Abstract Background Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity\/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF. Methods Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS)\u2009\u2265\u200914 assessed during the spontaneous breathing trial, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":347,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[147,145,146,144,37],"class_list":["post-464","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-chronic-obstructive-pulmonary-disease-copd","tag-noninvasive-ventilation","tag-postextubation-respiratory-failure","tag-reintubation","tag-weaning"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial - Perfusfind Intensive Care<\/title>\n<meta name=\"description\" content=\"Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity\/mortality. 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Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF. Methods Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS)\u2009\u2265\u200914 assessed during the spontaneous breathing trial,&hellip;","_links":{"self":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/464","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/comments?post=464"}],"version-history":[{"count":2,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/464\/revisions"}],"predecessor-version":[{"id":484,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/464\/revisions\/484"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media\/347"}],"wp:attachment":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media?parent=464"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/categories?post=464"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/tags?post=464"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}