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. 2025 Aug 6.
doi: 10.1007/s00134-025-08066-x. Online ahead of print.

Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation

Audrey De Jong  1   2 , Mathieu Capdevila  3   4 , Yassir Aarab  3   4 , Francesca Rabboni  3 , Alina Kozoriz  3 , Guillaume Heupel  3 , Joris Pensier  3   4 , Ines Lakbar  3 , Clément Monet  3   4 , Gérald Chanques  3   4 , Samir Jaber  3   4
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Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation

Audrey De Jong et al. Intensive Care Med. .

Abstract

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.

Keywords: Critical care; Extubation failure; ICU; Intensive care unit; Norepinephrine; Obesity; Vasopressors; Weaning.

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Conflict of interest statement

Declarations. Conflicts of interest: Pr. Jaber reports receiving consulting fees from Drager, Medtronic, Fresenius, Baxter, Mindray, and Fisher & Paykel. Pr De Jong reports receiving payments for presentations for Drager, Medtronic, Viatris, Mindray, and Fisher & Paykel. No potential conflicts of interest relevant to this article were reported for the other authors. Pr. Jaber is the Editor in Chief of Intensive Care Medicine. He has not taken part in the review or selection process of this article. Ethics committee approval: We obtained the approval from the ethic committee (Comité Local d’Ethique de la Recherche, agreement number: 198711) of the Montpellier University Hospital. The need for informed consent was waived.

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References

    1. Thille AW, Richard JC, Brochard L (2013) The decision to extubate in the intensive care unit. Am J Respir Crit Care Med 187:1294–1302 - PubMed
    1. Godet T, Chabanne R, Marin J, Kauffmann S, Futier E, Pereira B, Constantin JM (2017) Extubation failure in brain-injured patients: risk factors and development of a prediction score in a preliminary prospective cohort study. Anesthesiology 126:104–114 - PubMed
    1. Jung B, Vaschetto R, Jaber S (2020) Ten tips to optimize weaning and extubation success in the critically ill. Intensive Care Med 46:2461–2463 - PubMed - PMC
    1. Quintard H, l’Her E, Pottecher J, Adnet F, Constantin J-M, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C (2019) Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF). Ann Intensive Care 9:1–7
    1. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056 - PubMed

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