Intensivmedizin Fragen und Antworten

13 · Klinische Studien
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were no significant baseline differences in patient characteristics between
groups. The proportion of patients (protocol vs. UC) who successfully discontinued
mechanical ventilation (74.7 % vs. 75.2 %, p=0.92), duration of mechanical
ventilation (median [interquartile range]: 60.4 hours [28.6–167.0 hours]
vs. 68.0 hours [27.1–169.3 hours], p=0.61), ICU (25.3 % vs. 28.3 %) and hospital
mortality (36.4 % vs. 33.1 %), ICU length of stay (115 vs. 146 hours), and
rates of reinstituting mechanical ventilation (10.3 % vs. 9.0 %) was similar. We
conclude that protocol-directed weaning may be unnecessary in a closed ICU
with generous physician staffing and structured rounds.
Fazit
Auf einer geschlossenen Intensivstation mit guter ärztlicher Besetzung und strukturierten
Patientenvisiten erbrachte die Protokoll-gesteuerte Entwöhnung von
der Beatmung keine Vorteile.
jNicht invasive Beatmung bei respiratorischer Insuffizienz
nach Extubation
(n=221 Patienten, prospektive und randomisierte Studie)
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M, Epstein SK,
Hill NS, Nava S, Soares MA, D’Empaire G, Alía I, Anzueto A (2004) Noninvasive positivepressure
ventilation for respiratory failure after extubation. N Engl J Med 350: 2452–60
Background The need for reintubation after extubation and discontinuation of
mechanical ventilation is not uncommon and is associated with increased mortality.
Noninvasive positivepressure ventilation has been suggested as a promising
therapy for patients with respiratory failure after extubation, but a singlecenter,
randomized trial recently found no benefit. We conducted a multicenter,
randomized trial to evaluate the effect of noninvasive positive-pressure ventilation
on mortality in this clinical setting.
Methods Patients in 37 centers in eight countries who were electively extubated
after at least 48 hours of mechanical ventilation and who had respiratory failure
within the subsequent 48 hours were randomly assigned to either non invasive
positive-pressure ventilation by face mask or standard medical therapy.
Results A total of 221 patients with similar baseline characteristics had been
randomly assigned to either noninvasive ventilation (114 patients) or standard
medical therapy (107 patients) when the trial was stopped early, after an interim
analysis. There was no difference between the noninvasive-ventilation group
and the standard-therapy group in the need for reintubation (rate of reintubation,
48 percent in both groups; relative risk in the noninvasive-ventilation