This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200209-1074OCv1 168/1/70    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ferrer, M. Articles by Torres, A. Search for Related Content PubMed PubMed Citation Articles by Ferrer, M. Articles by Torres, A.

Noninvasive Ventilation during Persistent Weaning Failure

A Randomized Controlled Trial

Unitat de Vigilància Intensiva Respiratòria, Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona; and Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain

Correspondence and requests for reprints should be addressed to Correspondence and requests for reprints should be addressed to Miquel Ferrer, M.D., UVIR, Institut Clinic de Pneumologia i Cirurgia Toracica, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. E-mail: miferrer{at}clinic.ub.es

To assess the efficacy of noninvasive ventilation (NIV) 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 extubated, receiving NIV (n = 21), or remained intubated following a conventional-weaning approach consisting of daily weaning attempts (n = 22). Compared with the conventional-weaning group, the noninvasive-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 (ICU) (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 ICU (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 ICU (odds ratio: 6.6; p = 0.035) and 90-day survival (odds ratio: 3.5; p = 0.018). Earlier extubation with NIV 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

This article has been cited by other articles:

				N. Ambrosino and G. Vagheggini Noninvasive positive pressure ventilation in the acute care setting: where are we? Eur. Respir. J., April 1, 2008; 31(4): 874 - 886. [Abstract] [Full Text] [PDF]

				L. Lorente, S. Blot, and J. Rello Evidence on measures for the prevention of ventilator-associated pneumonia Eur. Respir. J., December 1, 2007; 30(6): 1193 - 1207. [Abstract] [Full Text] [PDF]

				O. Penuelas MD, F. Frutos-Vivar MD, and A. Esteban MD PhD Noninvasive positive-pressure ventilation in acute respiratory failure Can. Med. Assoc. J., November 6, 2007; 177(10): 1211 - 1218. [Abstract] [Full Text] [PDF]

				E. Garpestad, J. Brennan, and N. S. Hill Noninvasive Ventilation for Critical Care Chest, August 1, 2007; 132(2): 711 - 720. [Abstract] [Full Text] [PDF]

				J-M. Boles, J. Bion, A. Connors, M. Herridge, B. Marsh, C. Melot, R. Pearl, H. Silverman, M. Stanchina, A. Vieillard-Baron, et al. Weaning from mechanical ventilation Eur. Respir. J., May 1, 2007; 29(5): 1033 - 1056. [Abstract] [Full Text] [PDF]

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				A. A. El Solh, A. Aquilina, L. Pineda, V. Dhanvantri, B. Grant, and P. Bouquin Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients Eur. Respir. J., September 1, 2006; 28(3): 588 - 595. [Abstract] [Full Text] [PDF]

				O. Moerer, S. Fischer, M. Hartelt, B. Kuvaki, M. Quintel, and P. Neumann Influence of Two Different Interfaces for Noninvasive Ventilation Compared to Invasive Ventilation on the Mechanical Properties and Performance of a Respiratory System: A Lung Model Study Chest, June 1, 2006; 129(6): 1424 - 1431. [Abstract] [Full Text] [PDF]

				R Rodriguez-Roisin COPD exacerbations {middle dot} 5: Management. Thorax, June 1, 2006; 61(6): 535 - 544. [Abstract] [Full Text] [PDF]

				M. J. Jacka Ventilatory weaning for Goldilocks/Un sevrage ventilatoire pour Boucle d'Or. Can J Anesth, March 1, 2006; 53(3): 222 - 225. [Full Text] [PDF]

				K. E.A. Burns, N. K.J. Adhikari, and M. O. Meade A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation: [Une meta-analyse d'un sevrage non effractif pour faciliter le retrait de la ventilation mecanique]. Can J Anesth, March 1, 2006; 53(3): 305 - 315. [Abstract] [Full Text] [PDF]

				M. Ferrer, M. Valencia, J. M. Nicolas, O. Bernadich, J. R. Badia, and A. Torres Early Noninvasive Ventilation Averts Extubation Failure in Patients at Risk: A Randomized Trial Am. J. Respir. Crit. Care Med., January 15, 2006; 173(2): 164 - 170. [Abstract] [Full Text] [PDF]

				Additional Information JAMA, November 2, 2005; 294(17): E1 - E3. [Full Text] [PDF]

				S. Nseir, C. Di Pompeo, S. Soubrier, B. Cavestri, E. Jozefowicz, F. Saulnier, and A. Durocher Impact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD Chest, September 1, 2005; 128(3): 1650 - 1656. [Abstract] [Full Text] [PDF]

				I. Adachi, H. Ogino, H. Imanaka, H. Matsuda, K. Minatoya, and H. Sasaki Aortic root replacement in a patient with pulmonary dysfunction caused by severe chest deformity associated with Marfan syndrome J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 213 - 215. [Full Text] [PDF]

				A K Simonds Streamlining weaning: protocols and weaning units Thorax, March 1, 2005; 60(3): 175 - 182. [Full Text] [PDF]

				C. M. Parker and D. K. Heyland Aspiration and the Risk of Ventilator-Associated Pneumonia Nutr Clin Pract, December 1, 2004; 19(6): 597 - 609. [Abstract] [Full Text] [PDF]

				J. D. Truwit and G. R. Bernard Noninvasive Ventilation -- Don't Push Too Hard N. Engl. J. Med., June 10, 2004; 350(24): 2512 - 2515. [Full Text] [PDF]

				A. Tulaimat, B. Mokhlesi, M. Ferrer, and A. Torres Noninvasive Ventilation for Persistent Weaning Failure Am. J. Respir. Crit. Care Med., May 1, 2004; 169(9): 1073 - 1074. [Full Text]

				S. K. Aberegg, M. Ferrer, and A. Torres Noninvasive Ventilation and Weaning Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 882 - 882. [Full Text] [PDF]

				Additional articles abstracted in ACP Journal Club Evid. Based Med., March 1, 2004; 9(2): 35 - 35. [Full Text] [PDF]

				M. J. Tobin Critical Care Medicine in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 239 - 253. [Full Text] [PDF]

				Other articles noted: 25 Jul 03 to 7 Nov 03 Evid. Based Nurs., January 1, 2004; 7(1): e1 - 1. [Full Text] [PDF]

				L. Brochard Mechanical ventilation: invasive versus noninvasive Eur. Respir. J., November 16, 2003; 22(47_suppl): 31s - 37s. [Abstract] [Full Text] [PDF]

				T. T. Bauer Nosocomial Pneumonia: Therapy Is Just Not Good Enough Chest, November 1, 2003; 124(5): 1632 - 1634. [Full Text] [PDF]

				P. Navalesi Weaning and Noninvasive Ventilation: The Odd Couple Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 5 - 6. [Full Text] [PDF]