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Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation
Audrey De Jong1,2, Mathieu Capdevila3,4, Yassir Aarab3,4
1Intensive Care Unit, Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France. a-de_jong@chu-montpellier.fr.
Purpose:
The aim of this study was to assess whether norepinephrine at the time of extubation increases reintubation rates in critically ill patients with obesity.
Methods:
The initial step was to analyze data that had been collected prospectively, using a retrospective approach-defined as the main cohort. Then, we validated our findings using data from a multicenter randomized-controlled trial (validation cohort). The primary objective was to compare reintubation within 7 days, between patients with norepinephrine and without norepinephrine at the time of extubation. The secondary objective was to assess norepinephrine doses at extubation, normalized to body weight.
Results:
Among the 3186 patients included in the main cohort, 837 had obesity. Among them, 213 (25%) were extubated with norepinephrine, with a median norepinephrine dose at extubation of 0.6 mg/h of absolute value which corresponds to 0.097 (0.04-0.17) µg/kg/min of real body weight. No significant difference in reintubation rates was observed between patients extubated with norepinephrine (16%) and those without (17%, p = 0.85). Among the 656 patients with obesity in the validation cohort, we observed similar results, with a reintubation rate of 18% in those extubated with norepinephrine and 15% in those without (p = 0.45). Similar results were observed in the 2349 patients without obesity.
Interpretation:
In critically ill patients with obesity, the use of norepinephrine at the time of extubation did not significantly increase the reintubation rates.
Clinical Trial Registration:
NCT04014920 for the validation cohort.
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