title: Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery: A Randomized Clinical Trial.
abstract: OBJECTIVE
  It has not been established whether noninvasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery.
  
  
  OBJECTIVE
  To evaluate whether noninvasive ventilation improves outcomes among patients developing hypoxemic acute respiratory failure after abdominal surgery.
  
  
  METHODS
  Multicenter, randomized, parallel-group clinical trial conducted between May 2013 and September 2014 in 20 French intensive care units among 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure (partial oxygen pressure <60 mm Hg or oxygen saturation [SpO2] ≤90% when breathing room air or <80 mm Hg when breathing 15 L/min of oxygen, plus either [1] a respiratory rate above 30/min or [2] clinical signs suggestive of intense respiratory muscle work and/or labored breathing) if it occurred within 7 days after surgical procedure.
  
  
  METHODS
  Patients were randomly assigned to receive standard oxygen therapy (up to 15 L/min to maintain SpO2 of 94% or higher) (n = 145) or NIV delivered via facial mask (inspiratory pressure support level, 5-15 cm H2O; positive end-expiratory pressure, 5-10 cm H2O; fraction of inspired oxygen titrated to maintain SpO2 ≥94%) (n = 148).
  
  
  METHODS
  The primary outcome was tracheal reintubation for any cause within 7 days of randomization. Secondary outcomes were gas exchange, invasive ventilation-free days at day 30, health care-associated infections, and 90-day mortality.
  
  
  RESULTS
  Among the 293 patients (mean age, 63.4 [SD, 13.8] years; n=224 men) included in the intention-to-treat analysis, reintubation occurred in 49 of 148 (33.1%) in the NIV group and in 66 of 145 (45.5%) in the standard oxygen therapy group within+ 7 days after randomization (absolute difference, -12.4%; 95% CI, -23.5% to -1.3%; P = .03). Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days; absolute difference, -2.2 days; 95% CI, -0.1 to 4.6 days; P = .04), while fewer patients developed health care-associated infections (43/137 [31.4%] vs 63/128 [49.2%]; absolute difference, -17.8%; 95% CI, -30.2% to -5.4%; P = .003). At 90 days, 22 of 148 patients (14.9%) in the NIV group and 31 of 144 (21.5%) in the standard oxygen therapy group had died (absolute difference, -6.5%; 95% CI, -16.0% to 3.0%; P = .15). There were no significant differences in gas exchange.
  
  
  CONCLUSIONS
  Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01971892.
authors.affiliation: Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Saint Antoine Hospital, AP-HP, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lescot
authors.affiliation: Estaing Hospital, Clermont-Ferrand, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.affiliation: Beaujon Hospital, AP-HP, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.affiliation: Rennes University Hospital, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
authors.affiliation: Tours University Hospital, Tours, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Ferrandiere
authors.affiliation: Angers University Hospital, Angers, France.
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.affiliation: Poitiers University Hospital, Poitiers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.affiliation: Edouard Herriot Hospital, Lyon, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Hengy
authors.affiliation: Institut Paoli Calmettes, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Sannini
authors.affiliation: CHU Strasbourg, Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pottecher
authors.affiliation: Beaujon Hospital, AP-HP, Paris, France.
authors.forename: Paër-Sélim
authors.initials: PS
authors.lastname: Abback
authors.affiliation: Purpan Hospital, Toulouse, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Riu
authors.affiliation: Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Belafia
authors.affiliation: Estaing Hospital, Clermont-Ferrand, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.affiliation: Rennes University Hospital, Rennes, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Masseret
authors.affiliation: Saint Antoine Hospital, AP-HP, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Beaussier
authors.affiliation: Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Verzilli
authors.affiliation: Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: Lapeyronie University Hospital and Montpellier School of Pharmacy, Research Unit IMAG U5149, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
mesh_terms: D003428:Cross Infection / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007362:Intensive Care Units; D057194:Intention to Treat Analysis; D007442:Intubation, Intratracheal / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D019233:Retreatment / Q000706:statistics & numerical data; D013997:Time Factors