Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial
The study compared Non-Invasive Ventilation (NIV) and oxygen therapy post-extubation in critically ill obese patients across 39 French intensive care units. Patients were randomized into NIV or oxygen therapy groups, with a nested randomization for high-flow nasal oxygen or standard oxygen. The primary endpoint was treatment failure within three days post-extubation. The findings revealed a significant reduction in treatment failure in the NIV group (13.5%) compared to the oxygen therapy group (26.5%) (Relative Risk 0.43; 95% CI 0.31-0.60, p<0.0001). Reintubation rates within three days were similar in both groups in the intention-to-treat analysis, but lower in the NIV group in a post-hoc crossover analysis. The data supports the effectiveness of NIV in reducing treatment failure post-extubation, though further evidence is needed to determine if NIV inherently leads to better patient-centered outcomes.