Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice

Abstract

ObjectiveTo describe postextubation noninvasive positive pressure ventilation use in intensive care unit clinical practice and to identify factors associated with noninvasive positive pressure ventilation failure.MethodsThis prospective cohort study included patients aged ≥ 18 years consecutively admitted to the intensive care unit who required noninvasive positive pressure ventilation within 48 hours of extubation. The primary outcome was noninvasive positive pressure ventilation failure.ResultsWe included 174 patients in the study. The overall noninvasive positive pressure ventilation use rate was 15%. Among the patients who used noninvasive positive pressure ventilation, 44% used it after extubation. The failure rate of noninvasive positive pressure ventilation was 34%. The overall mean ± SD age was 56 ± 18 years, and 55% of participants were male. Demographics; baseline pH, PaCO2 and HCO3; and type of equipment used were similar between groups. All of the noninvasive positive pressure ventilation final parameters were higher in the noninvasive positive pressure ventilation failure group [inspiratory positive airway pressure: 15.0 versus 13.7cmH2O (p = 0.015), expiratory positive airway pressure: 10.0 versus 8.9cmH2O (p = 0.027), and FiO2: 41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure ventilation failure group. After fitting, the logistic regression model allowed us to state that patients with inspiratory positive airway pressure ≥ 13.5cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure compared with individuals with inspiratory positive airway pressure < 13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040).ConclusionThe noninvasive positive pressure ventilation failure group had a longer intensive care unit length of stay and a higher mortality rate. Logistic regression analysis identified that patients with inspiratory positive airway pressure ≥ 13.5cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure.

Non‐invasive mechanical ventilation in elderly patients: A narrative review

“…There is evidence that early application of NIV, immediately after extubation, is effective in preventing post-extubation respiratory failure in an at-risk population. [55][56][57] A systematic literature review that included randomized controlled trials comparing NIV with conventional oxygen therapy after planned extubation in medical ICU found that NIV decreased the reintubation rate in patients at high risk for extubation failure, with no difference between younger and older patients. 57 In the Table 1, the most available studies investigating the use of NIV in elderly patients in the hospital setting are summarized.…”

To: Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice

“…We carefully read the article by Yamauchi et al ( 1 ) on using noninvasive positive pressure ventilation (NIPPV) after extubation and congratulate the authors on their study. However, in the last few years, several studies with conflicting results have been published.…”

“…However, in the last few years, several studies with conflicting results have been published. ( 1 - 6 )…”

“…Data were collected over a seven-month period to describe post-extubation NIPPV use in an intensive care unit (ICU) in clinical practice and to identify factors associated with NIPPV failure. ( 1 ) Their study included 174 patients who received NIPPV after extubation. The failure rate of NIPPV was high (34%).…”

Reply to: Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice

“…In our study, ( 1 ) the parameters of noninvasive ventilation (NIV) that were evaluated were collected on the last day of NIV use, i.e., the day of NIV withdrawal due to either success or failure. The parameters at the time of collection were recorded and compared.…”