Published ahead of print on October 13, 2005, doi:10.1164/rccm.200505-718OC Am. J. Respir. Crit. Care Med., Volume 173, Number 2, January 2006, 164-170 A more recent version of this article appeared on January 15, 2006
Submitted on May 6, 2005 Early Non-Invasive Ventilation Averts Extubation Failure in Patients at Risk. A Randomized TrialMiquel Ferrer1*,1 Unitat de Cures Intensives i Intermedies, Servei de Pneumologia, Universitat de Barcelona, Institut Clinic del Torax, Barcelona, Spain, 2 Area de Vigilancia Intensiva, Universitat de Barcelona, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain * To whom correspondence should be addressed. E-mail: miferrer{at}clinic.ub.es.
Rationale. Respiratory failure after extubation and re-intubation are associated with increased morbidity and mortality. Objectives. To assess the efficacy of non-invasive ventilation in averting respiratory failure after extubation in patients at increased risk. Methods. A prospective randomized controlled trial was conducted in 162 mechanically-ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation. Patients were randomly allocated after extubation to receive non-invasive ventilation during 24 hours (n=79), or conventional management with oxygen therapy (control group, n=83). Measurements and Main Results. The primary end-point variable was the decrease of respiratory failure after extubation. In the non-invasive ventilation group, respiratory failure after extubation was less frequent (13, 16% vs 27, 33%, p=0.029) and the intensive care unit mortality was lower (2, 3% vs 12, 14%, p=0.015). However, 90-day survival did not change significantly between groups. Separate analyses of patients without and with hypercapnia (arterial CO2 tension >45mmHg) during the spontaneous breathing trial showed that non-invasive ventilation improved the intensive care unit mortality (0 vs 4, 18%, p=0.035) and 90-day survival (p=0.006) in hypercapnic patients only; of them, 98% had chronic respiratory disorders. Conclusions. The early use of non-invasive ventilation averted respiratory failure after extubation and decreased the intensive care unit mortality in patients at increased risk. The beneficial effect of non-invasive ventilation in improving survival in hypercapnic patients with chronic respiratory disorders warrants a new prospective clinical trial. Key words: Non-invasive ventilation; Mechanical ventilation; Weaning; Respiratory failure; Extubation failure.
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