Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial

Ferrer, Miquel; Sellarés, Jacobo; Valencia, Mauricio; Carrillo, Andrés; González, Guillermo; Badia, Joan R.; Nicolás, Josep M.; Torres, Antoni

doi:10.1016/s0140-6736(09)61038-2

Cited by 292 publications

(288 citation statements)

References 30 publications

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“…8 4 -8 7 High-risk patients were defined differently among the RCTs: 1) age greater than 65 years, cardiac failure as the cause of intubation or Acute Physiology and Chronic Health Evaluation (APACHE) II score greater than 12 at the time of extubation; 84 2) more than one of the following: failure of consecutive weaning trials, chronic cardiac failure, arterial pressure of carbon dioxide greater than 45 mm Hg after extubation, more than one noncardiac comorbidity, weak cough or stridor after extubation not requiring immediate intubation; 85 3) acute exacerbation of COPD 86 or 4) history of chronic respiratory disease with ventilation for more than 48 hours and hypercapnia during the spontaneous breathing trial. 87 Although the four trials defined higher risk differently, they reported consistent decreases in rates of reintubation (RR 0.42, 95% CI 0.25-0.70) and ICU mortality (RR 0.35, 95% CI 0.16-0.78) but less benefit in terms of hospital mortality (RR 0.66, 95% CI 0.42-1.04).…”

Section: After Planned Extubationmentioning

confidence: 91%

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Keenan¹,

Sinuff²,

Burns³

et al. 2011

Canadian Medical Association Journal

322

202

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Section: After Planned Extubationmentioning

confidence: 91%

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Keenan¹,

Sinuff²,

Burns³

et al. 2011

Canadian Medical Association Journal

322

202

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“…A subgroup analysis in one of these studies found in improvement in survival only in patients with hypercapnia during the spontaneous breathing trial (77). After these findings, the same group conducted a new RCT specifically in patients with chronic respiratory disorders and hypercapnia during a successful spontaneous breathing trial, with the same study design (78). The results from this study confirm again that the use of NIV immediately after extubation results in decreased incidence of respiratory failure after extubation and improved survival.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 55%

The art and science of non-invasive ventilation

Ferrer¹

2014

sob

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SummaryNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). NIV is considered a standard of care for the management of hypercapnic ARF in patients with acute exacerbation of chronic obstructive pulmonary disease. With an appropriate selection of patients, NIV can reduce the need for invasive mechanical ventilation, mortality and length of stay. Patients with severe hypoxemic ARF have in general a lower likelihood to need tracheal intubation when NIV as a support for ARF is added to the standard medical treatment. However, the effects of NIV on mortality are less evident, and the heterogeneity of the different published studies suggests that the efficacy may be different among different populations. The optimal time for intubation after NIV failure remains a challenging issue due to increasing evidences on the relationship between delayed intubation and excess mortality in these populations. In intubated patients with preexisting lung disease, the use of NIV in order to advance extubation during difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates and improved survival. Moreover, NIV immediately after extubation is effective in avoiding respiratory failure after extubation and improving survival in patients at risk for this complication, particularly those with chronic respiratory disorders, cardiac co-morbidity, and hypercapnic respiratory failure.KEY WORDS: non-invasive ventilation, acute respiratory failure, weaning, hypoxemic respiratory failure, hypercapnic respiratory failure. IntroductionNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). Non-invasive ventilation is ventilatory support through the upper airways of patients with an interface, usually a mask; therefore, tracheal intubation or a tracheostomy is not needed. The benefits of NIV appear to be the consequence of avoiding tracheal intubation and the associated morbidity and mortality (1, 2). There are several potential advantages for the use of NIV. Some patients can be managed out of an intensive care unit (ICU), a particularly stressful environment, with additional benefits in reducing the occupation of ICU beds and related costs. Ventilatory support can be intermittent and therefore withdrawal of NIV can be gradual. These patients can cooperate in respiratory therapy; they can receive nebulised therapy, expectorate and communicate with staff and their relatives. However, there are limitations for NIV. Unnecessary delay in intubation of those patients who fail with NIV treatment is associated with worse outcome (3). Some patients do not tolerate the mask due to claustrophobia or other causes, and nasal bridge skin breakdown can occur and difficult the use of NIV. Non-invasive ventilation is now considered as a firstline intervention in selected patients with severe exacerbation of chronic obstructive...

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“…Both studies showed that the groups treated with NIV had a lower re-intubation rate and a lower ICU mortality than the groups treated with standard therapy. Furthermore, one study [36] found a better 90-days survival in a subgroup of hypercapnic patients treated with NIV. To confirm the result found in this subgroup of patients, Ferrer and colleagues [36] performed a multi-centre randomized controlled trial specifically designed for patients who developed hypercapnia during an SBT.…”

Section: Niv and Post-extubation Failure Preventionmentioning

confidence: 98%

Weaning from Mechanical Ventilation and Post-Extubation Failure

et al. 2011

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In the event of acute respiratory failure, invasive mechanical ventilation (IMV) is a required practice to support gas exchanges and to unload respiratory muscles. It is important to optimise the timing of effective need of IMV. Weaning is defined as the process of gradual removal of mechanical ventilation support toward spontaneous ventilation. Non-invasive ventilation (NIV) efficacy have been proved only in a selected population of patients such as people with acute-on-chronic respiratory failure (COPD exacerbation) to shorten the length of invasive mechanical ventilation, the intensive care unit (ICU) stay and to avoid intubation related complications such as VAP. The role of NIV in all the other conditions (i.e. hypoxic patients, post-surgical patients) remains unclear. In the event of unplanned extubations during the weaning period, NIV could be considered as a good option to prevent re-intubation.

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Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial

Cited by 292 publications

References 30 publications

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

The art and science of non-invasive ventilation

Weaning from Mechanical Ventilation and Post-Extubation Failure

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