Noninvasive ventilation after early extubation in patients recovering from hypoxemic acute respiratory failure: a single-centre feasibility study

Abstract

In a highly experienced centre NIV may be used to facilitate discontinuation of mechanical ventilation in selected patients with resolving hypoxemic ARF.

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

“…In the current investigation [9], 40 % of patients randomized to NIV (and 50 % of controls) had respiratory failure caused by trauma. It is known that trauma patients can respond favorably to NIV [8,10].…”

“…In contrast, for patients recovering from hypoxemic respiratory failure intensivists have one choice: continue invasive mechanical ventilation until extubation [8]. In the current issue of Intensive Care Medicine, Vaschetto et al [9] raise the possibility that intensivists may have a second choice: the use of NIV to facilitate discontinuation of invasive mechanical ventilation.…”

“…The pilot study by Vaschetto et al [9] was designed to test the feasibility of using NIV to facilitate weaning in patients with resolving acute hypoxemic respiratory failure. Ten patients were randomized to invasive pressure support (PS, control group) and ten were randomized to noninvasive PS (NIV group).…”

“…Respiratory failure caused by any of these three etiologies usually responds poorly to NIV [8]. Unfortunately, Vaschetto et al [9] do not specify whether the positive results with NIV were driven by their trauma patients or not.…”

“…In the Italian study [9], the time for successful discontinuation of invasive and noninvasive ventilation after randomization ranged from zero to 25 days. That is, some patients were ready for unsupported breathing on study enrolment.…”