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L’administration de noradrénaline au moment de l'extubation ne devrait pas retarder l'extubation chez les patients de réanimation présentant une obésité

Authors
  • Heupel, Guillaume
Publication Date
Jun 30, 2023
Source
Hal-Diderot
Keywords
Language
English
License
Unknown
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Abstract

Purpose: the aim of this study was to examine in patients with and without obesity whether extubation while still receiving norepinephrine was associated with worse outcomes.Methods: we performed a retrospective analysis of prospectively collected data from January 1, 2016, to December 31, 2022, from a medical-surgical and transplantation unit of 20 beds. The percentage of patients extubated with norepinephrine and the dose of norepinephrine were assessed. The primary outcome was reintubation within 7 days. We assessed the associations of norepinephrine doses at extubation with reintubation within 7 days using Cox proportional-hazards models. The analyses were performed in patients with and without obesity. Results: among 2,349 patients included, 648 patients had obesity: 152 (23.5%) were extubated while receiving vasopressors, with a median norepinephrine dosage at extubation of 0.13 (0.06-0.23) mcg/kg/min of adjusted body weight. The incidence of reintubation within 7 days did not differ between the two groups: 16% (24 of 152 patients) in the group with norepinephrine compared to 15% (72 of 496 patients) in the group without norepinephrine (Hazard Ratio (HR) 1.1 (95% CI 0.7-1.7), p=0.71). Extubation with high-dose norepinephrine (≥0.19 mcg/kg/min) was associated with higher cumulative rate of reintubation within 7 days (adjusted HR=1.8 (95% CI 1.0-3.2), p=0.048). Similar results were observed in patients without obesity. Conclusions: a quarter of critically ill patients with and without obesity were extubated with norepinephrine. Extubation with low-dose norepinephrine was safe, whereas the clinician should be cautious when performing extubation in patients with norepinephrine dose ≥0.19 mcg/kg/min of adjusted body weight.

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