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Pulmonary

Star Research Presentations: Ventilation and Airway Management

Effects of Preoxygenation With Intratracheal Suctioning at Extubation: The INNOVATE Trial

Tuesday, February 25, 2025
12:15pm – 1:15pm Eastern Time
Location: Connections Central Theater 1
  • JP

    Josef Prazak, n/a (he/him/his)

    Department of Intensive Care Medicine, Inselspital, University Hospital Bern,

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • NS

    Noelle Schenk, N/A

    -
    School of Agriculture, Forest and Food Sciences, Bern University of Applied Sciences, Zollikofen, Switzerland

    Disclosure information not submitted.

  • JS

    Joerg Schefold, N/A

    Prof. MD
    Department of Intensive Care Medicine, Inselspital, University Hospital Bern, Bern, Switzerland

    Disclosure information not submitted.

  • KB

    Kaspar Bachmann, N/A

    MD
    Department of Intensive Care Medicine, Inselspital, University Hospital Bern, Bern, Switzerland

    Disclosure information not submitted.

  • DB

    David Berger, n/a

    Prof. MD
    Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland

    Disclosure information not submitted.

Disclosure(s):
Josef Prazak, n/a: No relevant financial relationship(s) to disclose.
Introduction: Extubation is a crucial event in the weaning process in any intubated patient hospitalized on the intensive care unit (ICU). Despite the fact, the evidence about the exact procedure of extubation and its potential implication on the patient outcome is lacking. It is unknown whether extubation with low inspired oxygen fraction and without intratracheal suctioning can improve the outcome of intubated patients on the ICU.


Methods: In a single center alternating cluster controlled trial, we compared two extubation strategies: preoxygenation with 100% fraction of oxygen (FIO2) together with intratracheal suction during extubation with the strategy with lower FIO2 (35%) and no airway suctioning. The primary outcome was the composite endpoint of the need for reintubation and/or non-invasive ventilation within 48 hours after extubation. The secondary outcomes were the single components of the primary endpoint, the need for nasal high-flow oxygenation or changes in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) after extubation. Differences in the primary and secondary outcomes were assessed using multiple logistic or multiple linear regression models.


Results: From Oct 19 to Dec 21, 3675 patients were included and assigned either into the high oxygen fraction and suctioning group (1877; 51.1%) or low oxygen fraction and no suctioning group (1798; 48.9%). In the high FIO2 group, 166 (8.8%) patients needed reintubation and/or non-invasive ventilation compared to 129 (7.2%) patients in the low FIO2 group. The treatment strategy with low FiO2 and no suctioning reduced the risk of reintubation and/or non-invasive ventilation within 48h by 23% (OR =0.77 [0.60 to 0.98], p = 0.032) compared to the treatment strategy with high FIO2 and suctioning. In the high FIO2 group, 95 (5.1%) patients needed further high-flow therapy within 48 hours versus 48 (2.7%) patients in the low FIO2 group (OR = 0.495 [0.34 - 0.71], p = 0.001).The P/F ratio was 4.72 kPa (4.12 to 5.32) higher in the low FiO2 oxygen group (p < 0.001).


Conclusions: In intubated patients on ICU, the extubation strategy without suction and with low oxygen fraction (35%) decreased the composite risk of reintubation or non-invasive ventilation after extubation and shows significant benefits on patients’ outcomes.