WIN IN WEAN
Trial question
What is the role of noninvasive ventilation alternating with high-flow nasal oxygen in ventilated patients at high risk of postextubation respiratory failure?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 227
227 patients (71 female, 156 male).
Inclusion criteria: ventilated patients without COPD at high risk of postextubation respiratory failure.
Key exclusion criteria: COPD; tracheostomy; tetraplegia; paraplegia above the 8th thoracic segment; unplanned extubation; do-not-reintubate order; lack of echogenicity.
Interventions
N=128 noninvasive ventilation plus HFNC (prophylactic 2 hour high-flow nasal oxygen alternating with 1-hour noninvasive ventilation during 2 days).
N=99 conventional oxygen (standard oxygen therapy).
Primary outcome
Respiratory failure within 48 hours
14.8%
28.3%
28.3 %
21.2 %
14.2 %
7.1 %
0.0 %
Noninvasive ventilation plus
HFNC
Conventional
oxygen
Significant
decrease ▼
NNT = 7
Significant decrease in respiratory failure within 48 hours (14.8% vs. 28.3%; RR 0.52, 95% CI 0.31 to 0.88).
Secondary outcomes
Significant decrease in respiratory failure at day 7 (23.8% vs. 38.4%; RR 0.62, 95% CI 0.44 to 0.96).
No significant difference in reintubation at day 7 (22.2% vs. 24.2%; RR 0.92, 95% CI 0.57 to 1.48).
No significant difference in death at day 90 (22.3% vs. 19.6%; RR 1.14, 95% CI 0.68 to 1.92).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In ventilated patients without COPD at high risk of postextubation respiratory failure, noninvasive ventilation plus HFNC was superior to conventional oxygen with respect to respiratory failure within 48 hours.
Reference
Jean-Jacques Rouby, Sébastien Perbet, Jean-Pierre Quenot et al. Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial. Crit Care. 2024 Nov 26;28(1):391.
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