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.
Thille AW, Ragot S, Frat J. Strategies to Avoid Extubation Failure Among ICU Patients—Reply. JAMA. 2020;323(9):892–893. doi:10.1001/jama.2019.21954
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