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Comment & Response
March 3, 2020

Strategies to Avoid Extubation Failure Among ICU Patients—Reply

Author Affiliations
  • 1Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
  • 2INSERM CIC 1402, ALIVE Research Group, Poitiers, France
JAMA. 2020;323(9):892-893. doi:10.1001/jama.2019.21954

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.1 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.