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

El-Solh, Ali; Aquilina, Alan T.; Pineda, Lilibeth A.; Dhanvantri, V; Grant, B; Bouquin, P

doi:10.1183/09031936.06.00150705

Cited by 173 publications

(91 citation statements)

References 27 publications

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“…NPPV has also been successfully used for the prevention of ARF in the first 48 h post-extubation in severely obese patients [89]. These data support the use of NPPV as a means of prevention of ARF in patients at high risk of extubation failure, in selected patients and in appropriate settings allowing for strict monitoring and prompt ETI.…”

Section: Post-extubation Respiratory Failurementioning

confidence: 53%

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Ambrosino¹,

Vagheggini²

2008

European Respiratory Journal

169

128

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Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions. Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NPPV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury, acute respiratory distress syndrome, or during bronchoscopy. NPPV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available. A trained team, careful patient selection and optimal choice of devices can optimise outcome of NPPV.Noninvasive positive pressure ventilation is increasingly being used in the management of acute respiratory failure but caregivers must respect evidence-supported indications and avoid contraidincations. Additionally, the technique must be applied in the appropriate location by a trained team in order to avoid disappointing results.

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Section: Post-extubation Respiratory Failurementioning

confidence: 53%

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Ambrosino¹,

Vagheggini²

2008

European Respiratory Journal

169

128

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“…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. The benefits of NIV in the prevention of respiratory failure after extubation were also documented in severely obese patients in a casecontrol study (79). In this study, the benefits in survival were also restricted in hypercapnic patients only.…”

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: 57%

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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“…NIV in selected chronic hypercapnic patients if applied within the first 48 hours post-extubation following established weaning protocols reduces hospital mortality. There was also a significant reduction of length of ICU and hospital stay [33]. This study has shown that the use of NIV in the first 48 hours post-extubation might be effective in avoiding respiratory failure.…”

Section: Niv As Weaning Strategymentioning

confidence: 66%

“…Only few studies address the problem of weaning in critically obese patients [32][33][34]. Currently, the management of these patients is based on clinical experience and expert opinions [33].…”

Section: Niv As Weaning Strategymentioning

confidence: 99%

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Predictors of Noninvasive Ventilation Failure in Critically Ill Obese Patients: A Brief Narrative Review

Nicolini¹,

Lemyze

Esquinas

et al. 2017

Advances in Respiratory Medicine

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Non-invasive ventilation ( NIV ) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades than previously. Unfortunately, NIV can have failure rates ranging from 5% to 50% and patient selection is the key to success. There are particular groups of patients that are more likely to benefit from NIV. For patients with hypoventilation syndrome (OHS) this treatment can be beneficial. This review seeks to evaluate the effectiveness of NIV in acute ARF and determine predictors of NIV failure in morbidly obese patients. Only a few studies have investigated NIV success or failure in these patients. NIV was most often effective when patients were carefully selected. Obese patients who exhibited early NIV failure had a high severity score at admission. In contrast, more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS had better prognosis and response to NIV than other hypercapnic patients. They required more aggressive NIV settings, a longer time to reduce paCO 2 levels, and more frequently a delayed but successful response to NIV which should encourage the use of NIV rather than early intubation. Since clear predictors of NIV failure have not been identified, a strict and prolonged monitoring is mandatory.

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

Cited by 173 publications

References 27 publications

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Noninvasive positive pressure ventilation in the acute care setting: where are we?

The art and science of non-invasive ventilation

Predictors of Noninvasive Ventilation Failure in Critically Ill Obese Patients: A Brief Narrative Review

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