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Evaluation of the role of noninvasive positive pressure ventilation in prevention of postextubation respiratory failure in high-risk patients

Introduction

Unsuccessful extubation (the need for reintubation) occurs in up to 20% of patients within 24–72 hours of planned extubation. Factors that appear to increase the risk are age >70 years, higher severity of illness at weaning onset, use of intravenous sedation, and longer duration of mechanical ventilation prior to extubation [1]. Reintubation is associated with increased hospital stay and mortality [2]. Noninvasive positive pressure ventilation (NIPPV) has been proposed in the management of acute respiratory failure occurring in the postextubation period. The use of NIPPV to prevent postextubation respiratory failure must therefore be considered.

Methods

Thirty high-risk patients for postextubation failure were enrolled in this study, and were divided into two groups. Group A received standard medical therapy just after extubation, while in group B NIPPV is applied just after extubation.

Results

Reintubation and NIPPV were applied in 8/15 patients (55.33%) in group A, while in group B it was 2/15 patients (13.33%). The improvement in oxygen extraction in group B after 48 hours of the study was greater than in group A (25.32 ± 0.69% and 27.89 ± 1.82%, respectively) (P = 0.004). The shunt fraction was significantly different (P = 0.001) after 48 hours between group A and group B (3.55 ± 0.35 and 2.92 ± 0.37, respectively).

Conclusion

NIPPV is an efficient means to prevent postextubation respiratory failure in high-risk patients when applied immediately after extubation.

References

  1. 1.

    Epstin SK: Endotracheal extubation. Respir Care Clin N Am 2000, 6: 321-326. 10.1016/S1078-5337(05)70072-1

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    Epstin SK: Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997, 112: 186-192. 10.1378/chest.112.1.186

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Naby, G.A., Habib, T. & Razik, A. Evaluation of the role of noninvasive positive pressure ventilation in prevention of postextubation respiratory failure in high-risk patients. Crit Care 12, P325 (2008). https://doi.org/10.1186/cc6546

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Keywords

  • Oxygen
  • Public Health
  • Hospital Stay
  • Mechanical Ventilation
  • Emergency Medicine