M. J. Tobin, Mechanical Ventilation, New England Journal of Medicine, 1994.

A. Esteban, A. Anzueto, F. Frutos, I. Alía, L. Brochard et al., Group for the MVIS: Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation: A 28-Day International Study, JAMA, vol.287, pp.345-55, 2002.

W. M. Coplin, D. J. Pierson, K. D. Cooley, D. W. Newell, and G. D. Rubenfeld,

, Extubation Delay in Brain-Injured Patients Meeting Standard Weaning Criteria, Am J Respir Crit Care Med, vol.161, pp.1530-1536, 2000.

D. J. Cook, Incidence of and Risk Factors for Ventilator-Associated Pneumonia in Critically Ill Patients, Annals of Internal Medicine, vol.129, p.433, 1998.

A. S. Slutsky and V. M. Ranieri, Ventilator-Induced Lung Injury, New England Journal of Medicine, vol.369, pp.2126-2162, 2013.

M. J. Bishop, Mechanisms of Laryngotracheal Injury Following Prolonged Tracheal Intubation, CHEST, vol.96, pp.185-191, 1989.

J. Tadié, E. Behm, L. Lecuyer, R. Benhmamed, S. Hans et al.,

J. Guérot and E. , Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study, Intensive Care Med, vol.36, pp.991-999, 2010.

A. Shafer, Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens, Critical Care Medicine, vol.26, p.947, 1998.

J. Boles, J. Bion, A. Connors, M. Herridge, B. Marsh et al.,

M. Stanchina, A. Vieillard-baron, and T. Welte, Weaning from mechanical ventilation, Eur Respir J, vol.29, pp.1033-56, 2007.

A. W. Thille, J. Richard, and L. Brochard, The Decision to Extubate in the Intensive Care Unit, Am J Respir Crit Care Med, vol.187, pp.1294-302, 2013.

C. Girault, M. Bubenheim, F. Abroug, J. L. Diehl, S. Elatrous et al., VENISE Trial Group: Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial, Am J Respir Crit Care Med, vol.184, pp.672-681, 2011.

A. W. Thille, F. Boissier, H. Ben-ghezala, K. Razazi, and A. Mekontso-dessap,

C. and B. L. , Easily identified at-risk patients for extubation failure may benefit from noninvasive ventilation: a prospective before-after study, Crit Care, vol.20, p.48, 2016.

J. Wang, Y. Ma, and Q. Fang, Extubation With or Without Spontaneous Breathing Trial

, Crit Care Nurse, vol.33, pp.50-55, 2013.

T. Miu, A. M. Joffe, N. D. Yanez, N. Khandelwal, A. H. Dagal et al., Predictors of reintubation in critically ill patients, Respir Care, vol.59, pp.178-85, 2014.

L. Robriquet, H. Georges, O. Leroy, P. Devos, D. 'escrivan et al., Predictors of extubation failure in patients with chronic obstructive pulmonary disease, J Crit Care, vol.21, pp.185-90, 2006.

L. Brochard, J. Mancebo, M. Wysocki, F. Lofaso, G. Conti et al.,

S. Benito, A. Gasparetto, F. Lemaire, D. Isabey, and A. Harf, Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease, New England Journal of Medicine, vol.333, pp.817-839, 1995.

J. Masip, A. J. Betbesé, J. Páez, F. Vecilla, R. Cañizares et al.,

J. Ballús, Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial, Lancet, vol.356, pp.2126-2158, 2000.

G. Hilbert, D. Gruson, F. Vargas, R. Valentino, G. Gbikpi-benissan et al.,

J. and C. Jp, Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure, N Engl J Med, vol.344, pp.481-488, 2001.

K. Bendjelid, N. Schütz, P. M. Suter, G. Fournier, D. Jacques et al., Does continuous positive airway pressure by face mask improve patients with acute cardiogenic pulmonary edema due to left ventricular diastolic dysfunction?, Chest, vol.127, pp.1053-1061, 2005.

L. Brochard, Physiologic Effects of Noninvasive Ventilation during Acute Lung Injury, Am J Respir Crit Care Med, vol.172, pp.1112-1120, 2005.

A. Esteban, F. Frutos-vivar, N. D. Ferguson, Y. Arabi, C. Apezteguía et al.,

S. K. Epstein, N. S. Hill, S. Nava, M. Soares, D. 'empaire et al., Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation, New England Journal of Medicine, vol.350, pp.2452-60, 2004.

S. P. Keenan, C. Powers, D. G. Mccormack, and G. Block, Noninvasive Positive-Pressure Ventilation for Postextubation Respiratory Distress: A Randomized Controlled Trial, JAMA, vol.287, pp.3238-3282, 2002.

I. Auriant, A. Jallot, P. Hervé, J. Cerrina, L. Roy-ladurie et al., Noninvasive Ventilation Reduces Mortality in Acute Respiratory Failure following Lung Resection, Am J Respir Crit Care Med, vol.164, pp.1231-1236, 2001.

S. Nava, C. Gregoretti, F. Fanfulla, E. Squadrone, M. Grassi et al., Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients, Crit Care Med, vol.33, pp.2465-70, 2005.

M. Ferrer, M. Valencia, J. M. Nicolas, O. Bernadich, J. R. Badia et al., Early Noninvasive Ventilation Averts Extubation Failure in Patients at Risk: A Randomized Trial

, American Journal of Respiratory and Critical Care Medicine, vol.173, pp.164-70, 2006.

M. Ferrer, J. Sellarés, M. Valencia, A. Carrillo, G. Gonzalez et al., Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial, Non-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial, vol.374, pp.1082-1090, 2009.

, Anaesth Intensive Care, vol.39, pp.217-240, 2011.

M. Truc and H. Quintard, Intubation et extubation du patient de réanimation, Anesthésie & Réanimation, vol.4, pp.190-197, 2016.

A. Zarbock, E. Mueller, S. Netzer, A. Gabriel, P. Feindt et al., Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients, Chest, vol.135, pp.1252-1259, 2009.

C. Lorut, A. Lefebvre, B. Planquette, L. Quinquis, H. Clavier et al.,

F. Bellenot, J. Regnard, M. Riquet, P. Magdeleinat, G. Meyer et al., Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial, Intensive Care Medicine, vol.40, pp.220-227, 2014.

E. Cuquemelle, T. Pham, J. Papon, B. Louis, P. Danin et al., Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure, Respir Care, vol.57, pp.1571-1578, 2012.

R. L. Parke and S. P. Mcguinness, Pressures Delivered By Nasal High Flow Oxygen During All Phases of the Respiratory Cycle, Respiratory Care, vol.58, pp.1621-1625, 2013.

A. Corley, L. R. Caruana, A. G. Barnett, O. Tronstad, and J. F. Fraser, Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients, British journal of anaesthesia, vol.107, pp.998-1004, 2011.

J. Frat, A. W. Thille, A. Mercat, C. Girault, S. Ragot et al.,

E. Morawiec and A. Cottereau, High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure, New England Journal of Medicine, vol.372, pp.2185-2196, 2015.
URL : https://hal.archives-ouvertes.fr/hal-01850556

S. M. Maggiore, F. A. Idone, R. Vaschetto, R. Festa, A. Cataldo et al.,

D. Gaetano, A. Navalesi, P. Antonelli, and M. , Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome, Am J Respir Crit Care Med, vol.190, pp.282-290, 2014.

G. Hernández, C. Vaquero, P. González, C. Subira, F. Frutos-vivar et al.,

L. Colinas, R. Cuena, and R. Fernández, Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial, JAMA, vol.315, p.1354, 2016.

G. Hernández, C. Vaquero, L. Colinas, R. Cuena, P. González et al.,

M. L. Rodriguez, A. Villasclaras, and R. Fernández, Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial, JAMA, vol.316, pp.1565-74, 2016.

Y. Ni, J. Luo, H. Yu, D. Liu, B. Liang et al., Can high-flow nasal cannula reduce the rate of reintubation in adult patients after extubation? A meta-analysis

, BMC Pulm Med, vol.17, p.142, 2017.

J. Nicolet, F. Poulard, D. Baneton, J. Rigal, and Y. Blanloeil,

, Ann Fr Anesth Reanim, vol.30, pp.331-335, 2011.

F. Stéphan, B. Barrucand, P. Petit, S. Rézaiguia-delclaux, A. Médard et al.,

B. Cosserant, G. Flicoteaux, A. Imbert, C. Pilorge, and L. Bérard,

, Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial, JAMA, vol.313, p.2331, 2015.

D. R. Ouellette, S. Patel, T. D. Girard, P. E. Morris, G. A. Schmidt et al.,

S. , N. R. Pawlik, A. J. Schweickert, W. D. Sessler, C. N. Strøm et al., Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians, Chest, vol.151, pp.166-80, 2017.

T. D. Girard, J. P. Kress, B. D. Fuchs, J. Thomason, W. D. Schweickert et al.,

D. B. Taichman, J. G. Dunn, A. S. Pohlman, P. A. Kinniry, J. C. Jackson et al., Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial, vol.371, p.9, 2008.

G. Capellier, H. Mockly, C. Charpentier, D. Annane, G. Blasco et al., Radiologic score by Weinberg, vol.26, 2012.

F. Stéphan, Y. Zarrouki, C. Mougeot, A. Imbert, T. Kortchinsky et al., Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes, vol.61, pp.324-356, 2016.

M. Singer, C. S. Deutschman, C. W. Seymour, M. Shankar-hari, D. Annane et al.,

R. Bellomo, G. R. Bernard, J. Chiche, C. M. Coopersmith, R. S. Hotchkiss et al., The Third International Consensus Definitions for Sepsis and Septic Shock, vol.315, pp.801-811, 2016.

J. Reis, J. C. Mota, P. Ponce, A. Costa-pereira, and M. Guerreiro, Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass, Eur J Cardiothorac Surg, vol.21, pp.1026-1056, 2002.

M. J. London, A. L. Shroyer, V. Jernigan, D. A. Fullerton, D. Wilcox et al.,

S. Mawhinney, K. E. Hammermeister, and F. L. Grover, Fast-track cardiac surgery in a Department of Veterans Affairs patient population, Ann Thorac Surg, vol.64, pp.134-175, 1997.

P. Dartevelle, É. Fadel, A. Chapelier, and A. E. , Traitement chirurgical de la maladie pneumopathies acquises sous ventilation mécanique, Annales Françaises d'Anesthésie et de Réanimation, vol.33, pp.404-409, 2014.

O. Schussler, M. Alifano, H. Dermine, S. Strano, A. Casetta et al.,

S. Coignard, A. Rabbat, and J. Regnard, Postoperative pneumonia after major lung resection, Am J Respir Crit Care Med, vol.173, pp.1161-1170, 2006.

H. Kehlet, Multimodal approach to control postoperative pathophysiology and rehabilitation, Br J Anaesth, vol.78, pp.606-623, 1997.

E. W. Ely, A. M. Baker, D. P. Dunagan, H. L. Burke, A. C. Smith et al.,

R. W. Browder, D. L. Bowton, and E. F. Haponik, Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously, New England Journal of Medicine, vol.335, pp.1864-1873, 1996.

L. Gattinoni, A. Protti, P. Caironi, and E. Carlesso, Ventilator-induced lung injury: the anatomical and physiological framework, Crit Care Med, vol.38, pp.539-548, 2010.

J. Stern and P. Girard, Suites opératoires en chirurgie thoracique, EMC -Pneumologie, vol.5, pp.1-14, 2008.

, Devenir des patients extubés hypoxémiques en chirurgie cardio-thoracique

, Le recours à la ventilation non invasive (VNI) ou à l'oxygénothérapie à haut débit nasal (OHDN) pourrait modifier la balance bénéfice/risque et plaider pour une extubation plus précoce. On se propose d'étudier le devenir de patients de chirurgie cardiothoracique, extubés alors qu'ils présentent un rapport P/F inférieur à 150 et dont l

, Nous avons recueilli de façon rétrospective les données des patients dont le rapport P/F avant extubation était inférieur à 150 et dont l'épreuve de VS était satisfaisante en postopératoire de chirurgie cardio-thoracique, Le critère de jugement principal était le taux de réintubation dans les 7 jours. Les données concernant les gaz du sang de J1 à J3

E. Juin, 98 patients ont été extubés alors qu'ils étaient hypoxémiques (PaO2/FiO2 = 134 ± 16), 2011.

, 3 % qui semble acceptable, en postopératoire de chirurgie cardio-thoracique. Il serait intéressant d'étudier comparativement deux stratégies différentes (maintien de l'assistance invasive versus extubation précoce aidée par les techniques non-invasives), notamment en termes de complications de l'intubation. Mots clés : Extubation, Hypoxémie, Chirurgie Cardiaque, Chirugie Thoracique, Ventilation non-invasive, associée à des techniques d'assistance respiratoire non invasive, a un taux d'échec de, vol.16