Article Dans Une Revue British Journal of Anaesthesia Année : 2025

Noninvasive ventilation in postoperative critically ill patients with morbid obesity: secondary analysis of the EXTUBOBESE multicentre randomised clinical trial

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 CHU Montpellier = Montpellier University Hospital
4 UM - Université de Montpellier
5 Université Paris-Saclay
6 Hôpital Marie-Lannelongue
7 Département Anesthésie, Réanimation et Soins Continus [Centre Jean Perrin - Clermont-Ferrand]
8 Neuro-Dol - Neuro-Dol
9 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
10 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
11 Team 6 - U1064 Inserm - CR2TI - Team 6 : Impact of acute inflammation on host pathogen interactions and lung homeostasis
12 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
13 Hôpital Nord [CHU - APHM]
14 CHPF - Centre Hospitalier de la Polynésie Française
15 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
16 Centre Hospitalier Universitaire [Rennes]
17 CHU Angers - Centre Hospitalier Universitaire d'Angers
18 CHU Pointe-à-Pitre / Abymes [Guadeloupe]
19 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
20 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
21 IMAGINE - Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts
22 OcciTRAUMA network
23 GRC 29 - ARPE - Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire
24 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
25 MOBIDIC - Microenvironment and B-cells: Immunopathology, Cell Differentiation, and Cancer
26 Hôpital Lapeyronie [CHU Montpellier]
27 HISCANT-MA - Histoire et Cultures de l'Antiquité et du Moyen Âge
28 Hôpital Beaujon [AP-HP]
29 Service d'Anesthésie et Réanimation [CHRU Nancy]
30 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
31 ToNIC - Toulouse NeuroImaging Center
32 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
33 CHU Gabriel Montpied [Clermont-Ferrand]
34 UNH - Unité de Nutrition Humaine
35 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
36 CHU Reims - Hôpital universitaire Robert Debré [Reims]
37 IPC - Institut Paoli-Calmettes
38 AP-HP - Hopital Saint-Louis [AP-HP]
39 HEGP - Hôpital Européen Georges Pompidou [APHP]
40 Hôpital Saint Eloi [CHU Montpellier]
41 UM - Université de Montpellier
42 UPCité - Université Paris Cité
43 IDESP - Institut Desbrest d'Epidémiologie et de Santé Publique
44 PREMEDICAL - Médecine de précision par intégration de données et inférence causale
Anne Bignon
Lucie Collet
Raiko Blondonnet
Yoann Launey

Résumé

Background - The optimal method to prevent treatment failure after tracheal extubation in postoperative critically ill patients with obesity and morbid obesity remains unknown. Methods - We conducted a secondary analysis of the EXTUBOBESE multicentre RCT comparing prophylactic noninvasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] and standard oxygen) in 585 postoperative critically ill patients with obesity (BMI ≥30 kg m) and morbid obesity (BMI ≥40 kg m). The primary outcome was treatment failure within 3 days after extubation, a composite of reintubation within 3 days (also analysed separately as secondary outcome), switch to the other study treatment, or premature study treatment discontinuation. The primary outcome analysis used a χ test. A Cox model was used for time without reintubation. Results - Treatment failure occurred in 39/292 patients (13.4%) in the NIV group and in 70/293 patients (23.9%) in the oxygen therapy group (absolute risk difference: -10.5; 95% confidence interval: -16.8 to -4.3). Similar results were found when analysing separately HFNO from standard oxygen in the oxygen therapy group. Reintubation rate was 8.6% (25 patients) in the NIV group and 9.9% (29 patients) in the oxygen therapy group (P=0.58). Interaction test was significant for level of obesity (P=0.045). Time without reintubation according to level of obesity significantly differed between NIV group and oxygen therapy group (P=0.02) in patients with BMI ≥40 kg m, but not in patients with 30≤BMI<40 kg m (P=0.70). Conclusions - Among postoperative critically ill adults with obesity undergoing tracheal extubation, our results suggest that use of noninvasive ventilation is effective to reduce treatment failure in comparison with oxygen therapy alone. These effects were more pronounced in patients with morbid obesity. Clinical trial registration - NCT04014920.

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hal-05298562 , version 1 (28-01-2026)

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Audrey de Jong, Helena Huguet, Anne Bignon, François Stephan, Thomas Godet, et al.. Noninvasive ventilation in postoperative critically ill patients with morbid obesity: secondary analysis of the EXTUBOBESE multicentre randomised clinical trial. British Journal of Anaesthesia, 2025, 135 (5), pp.1477-1485. ⟨10.1016/j.bja.2025.09.002⟩. ⟨hal-05298562⟩
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