EXTUB-OBESE
Trial question
What is the effect of noninvasive ventilation following extubation of critically ill patients with obesity?
Study design
Multi-center
Open label
RCT
Population
981 patients.
Inclusion criteria: critically ill patients with obesity undergoing extubation.
Key exclusion criteria: formal indication of noninvasive ventilation; pregnancy; tracheostomy; anatomical factors precluding the use of noninvasive ventilation.
Interventions
N=490 noninvasive ventilation (receipt of noninvasive ventilation).
N=491 oxygen therapy (receipt of standard oxygen therapy).
Primary outcome
Rate of treatment failure within 3 days
13.5%
26.5%
26.5 %
19.9 %
13.3 %
6.6 %
0.0 %
Noninvasive
ventilation
Oxygen
therapy
Significant
decrease ▼
NNT = 7
Significant decrease in the rate of treatment failure within 3 days (13.5% vs. 26.5%; RR 0.43, 95% CI 0.31 to 0.6).
Secondary outcomes
No significant difference in the rate of acute respiratory failure within 7 days after extubation (11% vs. 14%; RR 0.75, 95% CI 0.51 to 1.09).
No significant difference in the rate of reintubation within 3 days after extubation (10% vs. 12%; RR 0.8, 95% CI 0.53 to 1.19).
No significant difference in death at day 28 (5% vs. 6%; RR 0.87, 95% CI 0.51 to 1.49).
Conclusion
In critically ill patients with obesity undergoing extubation, noninvasive ventilation was superior to oxygen therapy with respect to the rate of treatment failure within 3 days.
Reference
Audrey De Jong, Anne Bignon, François Stephan et al. Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial. Lancet Respir Med. 2023 Jun;11(6):530-539.
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