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Published ahead of print on April 10, 2003, doi:10.1164/rccm.200209-1074OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 1, July 2003, 70-76

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Submitted on September 25, 2002
Accepted on April 2, 2003

NON-INVASIVE VENTILATION DURING PERSISTENT WEANING FAILURE. A RANDOMIZED CONTROLLED TRIAL

Miquel Ferrer1*, Antonio Esquinas2, Francisco Arancibia1, Torsten Thomas Bauer1, Gumersindo Gonzalez2, Andres Carrillo2, Robert Rodriguez-Roisin1, and Antoni Torres1

1 Institut Clinic de Pneumologia i Cirurgia Toracica, Hospital Clinic, Barcelona, Spain, 2 Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain

* To whom correspondence should be addressed. E-mail: miferrer{at}clinic.ub.es.

To assess the efficacy of non-invasive ventilation in patients with persistent weaning failure, we conducted a prospective, randomized, controlled trial in 43 mechanically ventilated patients who had failed a weaning trial for 3 consecutive days. This trial was stopped after a planned interim analysis. Patients were randomly allocated to be extubated receiving non-invasive ventilation (n=21), or to remain intubated following a conventional weaning approach consisting of daily weaning attempts (n=22). Compared with the conventional-weaning group, the non-invasive-ventilation group had shorter periods of invasive ventilation (through tracheal intubation) (9.5±8.3 vs 20.1±13.1 days, p=0.003) and intensive care unit (14.1±9.2 vs 25.0±12.5 days, p=0.002) and hospital stays (27.8±14.6 vs 40.8±21.4 days, p=0.026), less need for tracheotomy to withdraw ventilation (1, 5% vs 13, 59%, p<0.001), lower incidence of nosocomial pneumonia (5, 24% vs 13, 59%, p=0.042) and septic shock (2, 10% vs 9, 41%, p=0.045), and increased intensive care unit (19, 90% vs 13, 59%, p=0.045) and 90-day survival (p=0.044). The conventional weaning approach was an independent risk factor of decreased intensive care unit (odds-ratio: 6.6; p=0.035) and 90-day survival (odds-ratio: 3.5; p=0.018). Earlier extubation with non-invasive ventilation results in shorter mechanical ventilation and length of stay, less need for tracheotomy, lower incidence of complications and improved survival in these patients.
Key words: Mechanical ventilation, Noninvasive ventilation, Persistent weaning failure, Respiratory failure, Weaning




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