Preventive Use of Noninvasive Ventilation After Planned Extubation

Purpose:Till date, the benefit of using noninvasive ventilation (NIV) routinely after extubation to prevent reintubation has been conflicting. We aim to demonstrate the effect of targeted-volume NIV for the prevention of reintubation and extubation failure after planned extubation in medical intensive care unit (ICU) patients.Study Design:This was a prospective, randomized controlled study.Materials and Methods:Patients on invasive mechanical ventilation for more than 48 hrs for acute respiratory failure, who were ready for extubation, were randomized into targeted-volume NIV (intervention group) or oxygen mask (controlled group) immediately after extubation and continuously for 24 hrs.Results:A total of 58 patients were enrolled in this study. The targeted-volume NIV group was observed to have a trend toward lower reintubation rate within 48 hrs compared to oxygen mask group (0% vs. 17.2%; P = 0.052). Extubation failure rate within 48 hrs was significantly lower in targeted-volume NIV group compared to oxygen mask group (0% vs. 41.38%; P < 0.001). There was a trend toward lower ICU length of stay (6[5] days vs. 10[8] days (median interquartile range [IQR]); P = 0.053) as well as shorter hospital length of stay after extubation (10[19] days vs. 18[15] days (median [IQR]); P = 0.059). There were no differences in the incidence of ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (6.90% vs. 20.69%;P = 0.253) and 28 day-mortality (13.79% vs. 20.69%; P = 0.487).Conclusions:Our study is the first study to demonstrate the benefit of application of targeted-volume NIV immediately after extubation in reducing extubation failure rate. There was a trend toward lowering reintubation rate and shorter ICU length of stay and hospital length of stay after extubation in mixed medical ICU patients.

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“…[ 3 7 8 ] However, the benefit of utilization of NIV during postextubation in mixed medical ICU population has been conflicting. [ 7 9 10 11 ]…”

Section: Introductionmentioning

confidence: 99%

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Thanthitaweewat

Muntham

Chirakalwasan

2018

Indian Journal of Critical Care Medicine

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“…7 Investigators have also used NIV in asthma, pneumonia, neuromuscular disease, post-extubation, and hypoxemic and postoperative acute respiratory failure, with varying success. [8][9][10][11][12][13][14][15] The timing and location of initiation of NIV has been evaluated by investigators. Early commencement of NIV in appropriate patients is associated with better outcomes, because delay can adversely affect the patient and increase the need for invasive ventilation.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

et al. 2013

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BACKGROUND: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical emergency teams (METs) provide acute care and monitoring to deteriorating patients on the general wards. Whether it is safe for an MET to start NIV in ward patients with respiratory distress remains unclear. METHODS: We evaluated 1,123 MET calls in 30,217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital. We identified ward patients with acute desaturation (< 90%) and tachypnea (breathing frequency > 28 breaths/min), for whom an MET was called. Subjects transferred to the ICU at the end of an MET call were excluded. The remaining ward subjects were divided into 2 groups: patients who were not started on NIV by the MET; versus patients who were started on NIV by the MET. The primary outcome was endotracheal intubation or ICU transfer within 48 hours of MET activation. Secondary outcome measures were 28-day mortality and ICU mortality. RESULTS: Two hundred thirty-eight MET subjects met the study criteria, and 109 immediate ICU transfers were excluded. Of the remaining 129 ward subjects, 54 were in the NIV group, and 75 in the no-NIV group. The NIV group subjects were sicker (mean Acute Physiology and Chronic Health Evaluation II score 17.6 ؎ 5.1 versus 14.4 ؎ 5, P < .001). Subjects with pulmonary edema, COPD exacerbation, or asthma exacerbation were more likely, while those with pneumonia were less likely to be placed on NIV. The primary outcome was reached in 2/54 (3.7%) of the NIV subjects and 12/75 (16%) of the no-NIV subjects (P ‫؍‬ .03). There was no significant difference (P > .30) between the groups in 28-day mortality (7.4% vs 13.3%) or ICU mortality (3.7% vs 8%). CONCLUSIONS: In selected ward patients, especially those with COPD or pulmonary edema, NIV can be safely initiated by an MET.

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“…Pueden utilizarse tres estrategias de SRNI luego de la extubación (Tabla. 2) 11 : facilitadora, cuando permite una extubación precoz en pacientes seleccionados que han fracasado el ensayo de una PRE (prueba de respiración espontánea), con el objetivo de reducir la duración de la VMi y sus complicaciones asociadas; preventiva, en pacientes seleccionados y no seleccionados, con el objetivo de prevenir la FRA post extubación; terapéutica o "rescate", con el objetivo de tratar la FRA ya instaurada luego de la extubación.…”

Section: Estrategias Durante El Proceso De Extubaciónunclassified

Utilización de soportes respiratorios no invasivos post extubación en pacientes adultos críticos: revisión narrativa SRNI post extubación en adultos críticos

2023

Respirar

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La tasa de reintubación orotraqueal luego de la extubación se registra entre un 10 a 20%. La aplicación de soportes respiratorios no-invasivos (SRNI) posterior a la extubación como cánula nasal de alto-flujo, ventilación no invasiva (dos niveles de presión) y presión positiva continua en la vía aérea demostraron ser seguras y efectivas post extubación. El período pre-destete representa un momento crucial en el manejo de los pacientes críticos ya que el fracaso de la extubación, definido como la necesidad de reintubación dentro de los 2 a 7 días, demostró peores resultados al aumentar la mortalidad entre un 25-50%. Esta situación conlleva al requerimiento de ventilación mecánica prolongada, neumonía asociada a la ventilación mecánica y estancias prolongadas de internación. Por lo tanto, es esencial identificar a los pacientes que se beneficiarán utilizando SRNI post extubación.Palabras clave: destete, extubación, cánula nasal de alto-flujo, ventilación no invasiva.

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Preventive Use of Noninvasive Ventilation After Planned Extubation

Cited by 6 publications

References 16 publications

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

Utilización de soportes respiratorios no invasivos post extubación en pacientes adultos críticos: revisión narrativa SRNI post extubación en adultos críticos

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