Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

Abstract

Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO 2 , PCO 2 , and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as 'successfully weaned'. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.

Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

“…After excluding 334 duplicates and 3134 irrelevant citations, we reviewed the full text of the remaining 62 records. Finally, a total of 17 eligible RCTs [23,[26][27][28][37][38][39][40][41][42][43][44][45][46][47][48][49], representing 3341 patients, were included in this NMA. The PRISMA flowchart for study inclusion is shown in Fig.…”

“…Of the 17 included RCTs [23,[26][27][28][37][38][39][40][41][42][43][44][45][46][47][48][49], 10 [23, 26-28, 38, 41, 43-46] were multicenter, and 7 [37,39,40,42,[47][48][49] were single-center. All included RCTs were published in the last 15 years, and the number of participants ranged from 38 to 614.…”

“…Among these trials, however, 9 trials [37-40, 42, 44, 47-49] fulfilled the predefined criteria of a high risk of extubation failure in our NMA and were therefore classified as high risk, and the risk in the remaining 2 trials [43,46] was unclear. NIV was compared with COT in 9 trials [26,[37][38][39][40][41][42][43][44]. Four trials compared HFOT with COT [28,[45][46][47].…”

“…In all trials that involved NIV [23, 26, 27, 37-44, 48, 49], NIV was used with bilevel positive airway pressure mode. The PaCO 2 level at the end of SBT was less than 45 mmHg in 11 trials [23, 26-28, 40-42, 45-47, 49], greater than 45 mmHg in 4 trials [38,39,44,48], and unavailable in 2 trials [37,43]. Details regarding the characteristics and outcomes of each included study are described in Additional file 1 (Table S2 and S3).…”

“…2 and 3. All trials were assessed to be at low or unclear risk of bias in terms of adequate sequence generation and allocation concealment except for one trial [37] in which randomization was performed based on the admission number. Of note, all trials were judged as having a high risk of bias in blinding of participants and personnel because it was clinically impracticable due to virtual practice issues.…”