Should noninvasive positive pressure ventilation be used to prevent post-extubation respiratory failure?
© BioMed Central Ltd 2005
Published: 7 March 2005
The length of mechanical ventilation and the need for reintubation is associated with increased mortality. Weaning protocols are used to reduce the length of invasive ventilation. Noninvasive positive pressure ventilation (NPPV) has been suggested to shorten the length of intubation or to treat respiratory failure after extubation, but the study results are conflicting. We believe that NPPV can be useful to reduce the reintubation ratio when applied systematically and immediately after extubation in patients at risk for developing post-extubation respiratory failure.
To evaluate the use of NPPV immediately after extubation as part of a weaning protocol.
The data of consecutive patients mechanically ventilated for > 2 days, and who have been extubated, were collected before (pre-protocol group, 100 cases) and after the implementation of a weaning protocol (protocol group, 100 cases) in a high-complexity medical/surgical ICU. We compared the data of patients who used NPPV to treat respiratory failure in the first 48 hours after extubation (pre-protocol group) with the patients at risk for post-extubation respiratory failure (mechanical ventilation > 4 days, former T-trial failure, COPD and heart failure) who systematically used NPPV to prevent post-extubation respiratory failure (protocol group).
The population that used NPPV was similar in gender, days of mechanical ventilation before extubation (8.17 ± 6.8 vs 7.72 ± 3.78 days, P = 0.26) and proportion of COPD patients (28% vs 14%, P = 0.14) in the pre-protocol and protocol groups. NPPV was used in 70% of patients in the protocol group versus 28% of the pre-protocol (P < 0.001), with a lower NPPV failure ratio (reintubation < 48 hours) in proportion (10.7% vs 5.7%) but without differences in statistical analysis (P = 0.18). The ICU mortality for those patients who used NPPV was significantly lower in the protocol group 3.4% versus 34.8% pre-protocol (P < 0.001).
NPPV when used immediately after extubation, as part of a weaning protocol for patients at risk for post-extubation respiratory failure, is a safe intervention. Moreover, we report better results when comparing this technique with NPPV used to treat post-extubation respiratory failure.