• Kai Liu, Guang-Wei Hao, Ji-Li Zheng, Jing-Chao Luo, Ying Su, Jun-Yi Hou, Guo-Guang Ma, Shen-Ji Yu, Jun Li, Yong-Xin Sun, Hao Lai, Chun-Sheng Wang, Zhe Luo, and Guo-Wei Tu.
• Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
• Respir Care. 2020 Aug 1; 65 (8): 1160-1167.

BackgroundAcute 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.MethodsBeginning in December 2016, we transitioned our weaning strategy from repeated SBT until success (phase 1) to extubation concomitant with sequential NIV (phase 2) for subjects who failed their first SBT. The primary outcomes were re-intubation rate, duration of invasive ventilation, and total duration of ventilation.ResultsDuring 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 = .030). There were no significant differences between the 2 phases with regard to rates of re-intubation (7.5% vs 7.89%, P = .95), tracheostomy (2.5% vs 5.26%, P = .53), and in-hospital mortality (2.5% vs 2.63%, P = .97).ConclusionsEarly extubation 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.Copyright © 2020 by Daedalus Enterprises.

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