Extubation failure and the use of noninvasive ventilation during the weaning process in critically ill COVID-19 patients

Abstract

Objective To assess the outcome of extubation in COVID-19 patients and the use of noninvasive ventilation in the weaning process. Methods This retrospective, observational, single-center study was conducted in COVID-19 patients aged 18 years or older who were admitted to an intensive care unit between April 2020 and December 2021, placed under mechanical ventilation for more than 48 hours and progressed to weaning. Early extubation was defined as extubation without a spontaneous breathing trial and immediate use of noninvasive ventilation after extubation. In patients who underwent a spontaneous breathing trial, noninvasive ventilation could be used as prophylactic ventilatory assistance when started immediately after extubation (prophylactic noninvasive ventilation) or as rescue therapy in cases of postextubation respiratory failure (therapeutic noninvasive ventilation). The primary outcome was extubation failure during the intensive care unit stay. Results Three hundred eighty-four extubated patients were included. Extubation failure was observed in 107 (27.9%) patients. Forty-seven (12.2%) patients received prophylactic noninvasive ventilation. In 26 (6.8%) patients, early extubation was performed with immediate use of noninvasive ventilation. Noninvasive ventilation for the management of postextubation respiratory failure was administered to 64 (16.7%) patients. Conclusion We found that COVID-19 patients had a high rate of extubation failure. Despite the high risk of extubation failure, we observed low use of prophylactic noninvasive ventilation in these patients.

The COVID-19 Tracheostomy Experience at a Large Academic Medical Center in New York during the First Year

“…More recent literature has shown that patients with COVID-19 once intubated have high rates of extubation failure with low use of prophylactic noninvasive ventilation (NIV). [28] Additional studies have shown that extubation to NIV can decrease the rates of reintubation but without increasing length of stay or mortality. [29] Our study looked at tracheostomies' outcomes for all COVID-19 patients at Mount Sinai Hospital based on the timing of the tracheostomy over a period of 1 year.…”