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
Accepted on October 10, 2005
Early Non-Invasive Ventilation Averts Extubation Failure in Patients at Risk. A Randomized Trial
Miquel Ferrer1*, Mauricio Valencia1, Josep Maria Nicolas2, Oscar Bernadich1, Joan Ramon Badia1, and Antoni Torres1
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.
This article has been cited by other articles:
|
|
|
|
 
J. Sellares, I. Acerbi, H. Loureiro, R. L. Dellaca, M. Ferrer, A. Torres, D. Navajas, and R. Farre
Respiratory impedance during weaning from mechanical ventilation in a mixed population of critically ill patients
Br. J. Anaesth.,
November 3, 2009;
(2009)
aep301v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Ferreira, D. W. Chipman, N. S. Hill, and R. M. Kacmarek
Bilevel vs ICU Ventilators Providing Noninvasive Ventilation: Effect of System Leaks: A COPD Lung Model Comparison
Chest,
August 1, 2009;
136(2):
448 - 456.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K. Epstein
Weaning From Ventilatory Support
ACCP Crit Care Med Brd Rev,
January 1, 2009;
20(0):
213 - 226.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
E. B. Milbrandt, A. Ishizaka, and D. C. Angus
Update in Critical Care 2006
Am. J. Respir. Crit. Care Med.,
April 1, 2007;
175(7):
638 - 648.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Moss
Clinical Year in Review III: Critical Care, Mechanical Ventilation, Sleep Medicine, and Lung Cancer
Proceedings of the ATS,
November 1, 2006;
3(8):
645 - 649.
[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]
|
|
|
|
|
|
|
F. Onorati, L. Cristodoro, M. Bilotta, B. Impiombato, F. Pezzo, P. Mastroroberto, A. di Virgilio, and A. Renzulli
Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease.
Ann. Thorac. Surg.,
July 1, 2006;
82(1):
35 - 43.
[Abstract]
[Full Text]
[PDF]
|
|
|
Copyright © 2005 American Thoracic Society
|
|
|
