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.

Non-Invasive Positive Pressure Ventilation Versus Conventional Oxygen Therapy After Extubation in Patients With Hypercapnic Respiratory Insufficiency

“…Also in Ferrer et al, [15] respiratory failure after extubation was less frequent in noninvasive ventilation group, (n=13, 16%) vs. (n=27, 33%) in conventional management with oxygen therapy group (p = 0.029). In contrast with the present study, in mixed populations of patients with respiratory failure after extubation, use of noninvasive ventilation to avoid reintubation was successful in fewer patients (28%) with no advantages noted over standard medical treatment [16]. From this study it was found that, the mortality rate in NIPPV group I (8%) was significantly lower than in conventional oxygen therapy group (24%).…”

Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

“…All the centers participating in this study, however, had incorporated noninvasive ventilation into their routine clinical practices at least one year before the start of the study. In addition, the findings in the study by Keenan et al, 14 in which a oneyear training period was undertaken before the start of the trial, were similar to ours. Second, the timing of the initiation of noninvasive ventilation could be important.…”

Noninvasive positive pressure ventilation is required following extubation at the pulmonary infection control window: a prospective observational study

“…This suggests that the respiratory distress after extubation was not due to the recurrence of pulmonary infection, but rather to incomplete recovery of patients' capacity to breathe spontaneously. Our rate of distress was much higher than the 23%-25% reported in two previous studies (13,15), but that is predominantly because all of our patients had COPD, whereas only 9%-11% in those previous studies did. Shang et al (33) found that the amplitude of esophageal pressure in patients with a PIC window was 20 ± 6 cmH 2 O after liberation from positive ventilatory support, much higher than the ∼5 cmH 2 O in healthy people, suggesting that AECOPD patients work significantly harder to breathe compared with healthy people.…”