Noninvasive Positive-Pressure Ventilation for Postextubation Respiratory Distress

Keenan, Sean; Powers, Caroline; McCormack, David G.; Block, Gary

doi:10.1001/jama.287.24.3238

Cited by 352 publications

(225 citation statements)

References 25 publications

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“…71 Notably, the earlier study excluded patients with COPD after the first of 4 years of recruitment, 70 and in the second study too few patients with COPD were available to be analyzed separately. 71 Others have raised concerns that noninvasive positive-pressure ventilation was not optimally applied in either trial.…”

Section: 71mentioning

confidence: 99%

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: 71mentioning

confidence: 99%

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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“…Two randomised controlled trials [6,7] involving a heterogenous group of patients found that the use of NIV post-extubation did not reduce the rate of reintubation when compared with standard medical therapy.…”

Section: Prevention Of Post-extubation Failurementioning

confidence: 99%

“…Most of the published studies assessing the use of NIV in acute respiratory failure have relied on oro-nasal or facial masks [6,7,18,19]. Although there are no published studies, to the current authors' knowledge, on the superiority of one method over the other in the obese population, prior experience suggests a better tolerance for nasal masks in the morbidly obese, because these tend to be less claustrophobic.…”

Section: Prevention Of Post-extubation Failure Aa El Solh Et Almentioning

confidence: 99%

“…However, randomised controlled studies in nonobese patients have shown mixed results. While earlier studies failed to show any benefit from rescue NIV [6,7], a more recent investigation has documented a beneficial effect of administering NIV immediately postextubation in selected patients at increased risk for extubation failure [8]. FERRER et al [8] have shown not only a reduction in the rate of respiratory failure but also a decrease in the rate of intensive care unit (ICU) mortality.…”

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confidence: 99%

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Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

El-Solh

Aquilina²,

Pineda³

et al. 2006

European Respiratory Journal

173

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Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation.Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index o35 kg?m -2 ) were assigned to NIV via nasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation.Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9-29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group.In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.

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“…Two RCTs on the use of NIV in the treatment of respiratory failure after extubation did not show benefits from NIV in avoiding re-intubation (72,74). The first trial selected 81 patients with different underlying diseases, and did not find any benefit from NIV in terms of re-intubation, duration of mechanical ventilation and stay, and survival (74).…”

Section: Non-invasive Ventilation In the Management Of Respiratory Famentioning

confidence: 99%

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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Noninvasive Positive-Pressure Ventilation for Postextubation Respiratory Distress

Abstract: The addition of NPPV to standard medical therapy does not improve outcome in heterogeneous groups of patients who develop respiratory distress during the first 48 hours after extubation.

Cited by 352 publications

References 25 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

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

The art and science of non-invasive ventilation

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