Effect of sequential noninvasive ventilation on early extubation after acute type a aortic dissection

Abstract

BACKGROUND: Acute type A aortic dissection (aTAAD) is associated with a high incidence of prolonged postoperative invasive mechanical ventilation. We aimed to assess whether sequential noninvasive ventilation (NIV) could facilitate early extubation postoperatively after a spontaneous breathing trial (SBT) failure among aTAAD patients. METHODS: Beginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extuba-tion concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The pri-mary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation. RESULTS: During the study period, 78 subjects with aTAAD failed their first postoperative SBT (38 subjects in phase 1 and 40 subjects in phase 2). Subjects extubated with sequential NIV had shorter median (interquartile range [IQR]) duration of invasive ventilation of 39.5 (30.8–57.8) h vs 89.5 (64–112) h (P < .001) and median (IQR) length of ICU stay of 6 (4.0– 7.8) d vs 7.5 (5.8–9.0) d (P 5 .030). There were no significant differences between the 2 phases with regard to rates of re-intubation (7.5% vs 7.89%, P 5 .95), tracheostomy (2.5% vs 5.26%, P 5 .53), and in-hospital mortality (2.5% vs 2.63%, P 5 .97). CONCLUSIONS: Early extuba-tion followed by sequential NIV significantly reduced duration of invasive ventilation and length of ICU stay without increasing re-intubation rate in postoperative subjects with aTAAD who failed their first SBT.