19th International Symposium on Intensive Care and Emergency Medicine
- Meeting abstract
Noninvasive mechanical ventilation (NIMV) in weaning failure: could be an alternative approach?
Critical Care volume 3, Article number: P027 (2000)
A trial with noninvasive ventilation (NIMV) could be a safe alternative option in some selected unweanneable patient, after a period of invasive approach of weaning with: 1) Endotracheal tube (ET) or 2) Traqueostomizated with a `T' oxygen or Pressure support Ventilation (PSV) trials.
We show a cases series where NIMV have been applied as an alternative weaning technique in three difference clinical situations of unweanneability: 1) Post-extubation failure n = 12, 2) Decanulation in traqueostomizated n = 1, and 3) Elective extubation n = 3.
NIMV with BiPAP ST-D (Resp, Inc) ventilator, facial mask.
Inclusion criteria: acute respiratory insufficiency in a period (0–48 h): respiratory rate >30 rpm, increase accessory respiratory muscular activity, hypoxemia PaO2 < 60 mmHg at mask venturi (FIO2: 0.5) after a period of `T' piece or PSV and almost four consecutive weaning failure trials. Excluded: hemodynamic instability (SAT < 90 mmHg), uncooperative patients, and excessive secretions., IPAP/EPAP cmH2O to achieve: >10 ml/Kr and decrease in dysnea Borg score. Continuous cardiorespiratory monitoring.
Unweanneable population n = 16. Average age: 61 ± 20, male n = 12; APACHE II score: 21 ± 3, time of NIMV: 72 ± 12 h.
NIMV was effective in reduce dysnea Borg scores (4 to 2), gasometric alterations and avoid reintubation 8/12. Causes of exclusion: secretions 23%, hemodynamic instability 15%. Complications: skin lesion n = 2, gastric distension n = 1.
1). A trial with a NMV as a weaning alternative technique is a safe alternative in selected patients with showed a persistent weaning failure. 2). Reduction in ICU stay, mortality, with a great comfort and few complications compare to others method.
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Esquinas, A., González, D., Carrillo, A. et al. Noninvasive mechanical ventilation (NIMV) in weaning failure: could be an alternative approach?. Crit Care 3 (Suppl 2), P027 (2000). https://doi.org/10.1186/cc402
- Hemodynamic Instability
- Facial Mask
- Respiratory Insufficiency
- Muscular Activity
- Pressure Support Ventilation