Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Abstract

Background: Extubation failure (EF) is high in patients on mechanical ventilation for more than 7 days. However, strategies to prevent EF in this population are lacking. Aims: To evaluate the efficacy of preventive use of noninvasive ventilation in patients on mechanical ventilation for more than 7 days. Methods: We performed a retrospective study in an intensive care unit of a teaching hospital. We enrolled patients who received mechanical ventilation for more than 7 days and successfully completed a weaning trial. After extubation, patients who immediately received non-invasive ventilation (NIV) were classified as the NIV group, and those who received conventional oxygenation therapy only were classified as the usual care group. Results: We enrolled 95 patients in the NIV group and 61 patients in the usual care group. NIV is associated with reduced risk of EF compared to usual care both 72 h following extubation (11.6% vs 32.8%, P < 0.01, for the overall cohort; 8.6% vs 42.9%, P < 0.01, for the propensity-matched cohort) and 7 days following extubation (25.3% vs 45.9%, P < 0.01, for the overall cohort; 28.6% vs 51.4%, P = 0.09, for the propensity-matched cohort). Within 7 days of extubation, the NIV group had a lower proportion of EF than the controls (log rank test: P < 0.01 and P = 0.02 for the overall and propensity-matched cohorts, respectively). Conclusions: In patients on mechanical ventilation for more than 7 days, preventive use of NIV is associated with a reduction in EF.

Association of Extubation Failure Rates With High-Flow Nasal Cannula, Continuous Positive Airway Pressure, and Bilevel Positive Airway Pressure vs Conventional Oxygen Therapy in Infants and Young Children

“…Extubation failure (EF) is an important event that is associated with poor clinical outcomes in pediatric intensive care units (PICUs) . Postextubation noninvasive respiratory support (NRS), including high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP), is frequently used in PICUs in an attempt to reduce the risk of EF.…”

“…Extubation failure (EF) is an important event that is associated with poor clinical outcomes in pediatric intensive care units (PICUs). 1 , 2 , 3 Postextubation noninvasive respiratory support (NRS), including high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP), is frequently used in PICUs in an attempt to reduce the risk of EF. Several randomized clinical trials and observational studies have tried to evaluate the efficacy of various modes of NRS, but based on the current evidence, it is unclear whether NRS is superior to conventional oxygen therapy (COT) in preventing EF and which type of NRS is the most effective.…”