Contribution of noninvasive ventilation in the precocious extubation in the medical ICU

Introduction

During the past decade, noninvasive ventilation (NIV) has imposed itself as an alternative to endotracheal intubation. Several recent studies let us believe that this technique could be also beneficial at the precocious extubation. The purpose of our survey is to value the place of NIV at the precocious extubation in ventilated patients.

Methods

A prospective, randomized and controlled survey has been driven in a medical resuscitation unit during 6 months (June to December 2007). After 48 hours of mechanical ventilation (MV), if the patients have no fever, no neurological anomalies nor hemodynamic instability and SaO₂ >90% with 40% FiO₂, a spontaneous breathing trial (T-piece) is performed. If after the T-piece test the clinical status, blood gas and hemodynamic data were good, the patient was extubated. If these criteria were not filled, the MV was continued and a daily assessment performed. On the other hand, if the patient was anxious, agitated, with polypnea >35/minute, PaO₂ <50 mmHg under 40% FiO₂, heart rate >145/minute, systolic arterial pressure >170 mmHg or <70 mmHg or arrhythmia, the patient is randomized for one of the two protocols: in the first, the patient was extubated and NIV (pressure support – positive end-expiratory pressure) via a facial mask was performed; in the second, a classic weaning was performed with pressure support ventilation. The quantitative variables are expressed as the average or median ± standard derivation, and the qualitative variables by as the percentage. The univariate analysis was based on the chi-squared test or Fisher test for the qualitative variables and the Student test for the quantitative ones. P < 0.05 is considered significant. The statistic analysis was based on SPSS 11.0 for Windows.

Results

Twenty-four patients (13 men and 11 women) were enrolled (12 in each group: NIV group and control group). The mean age was 42 ± 2 years. The length of hospitalization for the NIV group is less than that for the control group (P = 0.001). The weaning of MV was more precocious in the NIV group than in the control group (P = 0.001). Also, nosocomial pneumonia occurred less in the NIV group than in the control group (P = 0.04). No case of mortality was noticed.

Conclusion

It seems that NIV permits one to shorten the duration of MV and length of stay in the ICU at the precocious extubation.