Clinical Efficacy Of Invasive-noninvasive Sequential Ventilation In Patients With Acute Type Ⅰ Respiratory Failure

Objective:To explore the clinical efficacy of early extubation followed by noninvasive ventilation(NIV)compared with standard extubation in patients with acute type Ⅰ respiratory failure.Methods:Prospective,randomized,clinical trial enrolling patients with acute type Ⅰ respiratory failure between October 14,2020 to October 27,2021 from one intensive care units(ICU)of Guizhou Medical University Affiliated Hospital.Patients were randomly assigned to control group(standard extubation)and sequential group(immediate extubation followed by NIV)when the weaning criteria were met.Primary outcome was the duration of IMV.Secondary outcomes were the duration of total ventilation,length of ICU stay,length of hospital stay,ICU mortality,hospital mortality,28-day and 60-day mortality,and ventilator associated pneumonia(VAP),weaning failure,reintubation,and tracheostomy.Results:A total of 102 patients were enrolled during the study period,and were randomly assigned to 51 patients in the control group and 51 patients in the sequential group.Compared to the control group,the duration of IMV was significantly shorter in the sequential group [d: 5.7(3.8,9.7)vs.4.6(3.2,7.1);p = 0.023].The duration of total mechanical ventilation [d: 5.7(3.8,9.7)vs.5.7(3.9,8.2),p = 0.666],the length of ICU stay [d: 11.9(6.8,18.0)vs.10.5(6.5,17.9),p = 0.618] and length of hospital stay [d: 24.5(19.4,36.0)vs.26.7(18.6,39.6),p = 0.720] were not significantly different.The incidence of VAP in the sequential group was significantly lower than control group [17.6%(9/51)vs.3.9%(2/51);p = 0.025].There were no significant differences in ICU mortality,hospital mortality,28-day mortality,60-day mortality.The adverse events such as weaning failure,reintubation,and tracheostomy between the two groups were not significantly different.Subgroup analysis showed that among patients with pulmonary infection on admission to the ICU,compared with the control group the duration of IMV [d: 8.0(5.1,9.9)vs.4.6(3.2,6.5);p = 0.001],total ventilation [d: 8.0(5.1,9.9)vs.5.7(3.9,7.5),p = 0.028] and the length of ICU stay[d: 13.3(10.3,18.0)vs.9.4(6.3,14.4),p = 0.025] significantly shortened in the sequential group,the difference was statistically significant.Conclusions:Invasive-noninvasive sequential mechanical ventilation reduced the days spent on IMV and the incidence of VAP.There was no increase in the incidence of adverse events such as weaning failure,reintubation,tracheostomy,and mortality.For acute type Ⅰ respiratory failure patients with pulmonary infection at the time of admission to the ICU,invasive-noninvasive sequential mechanical ventilation not only reduced the days spent on IMV,but also reduced the total ventilation and ICU stay,thus the weaning strategy of invasive-noninvasive sequential mechanical ventilation may have better clinical efficacy for these patients.