IntroductionNoninvasive ventilation (NIV) as a weaning facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients is associated with reduced ventilator associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF). Methods: A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours and 24 hours after extubation, re-intubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay and hospital mortality. Results: Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cmH2O, positive end expiratory pressure (PEEP) of 5 cmH2O, oxygen inspiratory fraction (FiO2) < 40%, arterial oxygen saturation (SaO2) > 90%, ratio of respiratory rate and tidal volume in liters (f/TV) < 105. Comparing the 20 patients (NIV) versus the 18 patients (OM) that finished the study forty-eight hours after extubation, the rate of re-intubation in NIV group was 5% and 39% in OM group (p=0.016). Relative risk for re-intubation was 0.13 (CI=0.017-0.946). Absolute risk reduction for re-intubation showed a decrease of 33.9%, and analysis of the number needed to treat was 3. No difference was found in the length of ICU stay (p=0.681). Hospital mortality was 0% in NIV group and 22.2% in OM group (p= 0.041). Conclusions: In this study population, NIV prevented 48 hours re-intubation if applied immediately after elective extubation in patients with more than three days of ARF when compared to OM group.Trial Registration number: ISRCTN: 41524441.



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BioMed Central - Latest Articles Carmen SV Barbas johalputt

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