Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients

Abstract

BACKGROUND:Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation.METHODS:We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days.RESULTS:The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01).CONCLUSION:The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.

Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

“…No difference was found between the groups. We observed that clinical practice reflects the findings of the literature, which recommends the early use of NPPV after extubation ( 19 - 22 ).…”

Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

“…Mechanical ventilation-related adverse events and safety issues have been studied extensively in experimental ( 9 ) and clinical trials ( 10 ),( 11 ) that emphasize the importance of early extubation. The laparoscopic approach to DPS implantation in our SCI patients was a safe and efficient procedure with no severe complications.…”

Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay

“…23 Standardizing practical approaches becomes necessary to help teams to make the most appropriate decision, favoring the clinical outcomes of patients. In this context, the development of care guidelines has been widely used in the routine in different fields of medical activity, 15,16 providing practical recommendations when scientific evidence is still limited or questionable. 23 Therapeutic resources such as incentive spirometry, CPAP, EPAP, early mobilization, and conventional physical therapy, based on deep breathing exercises, are often used to prevent atelectasis in patients undergoing UAS.…”

“…We used a ''before and after'' model of retrospective study with historical control. 15,16 The ''before'' period (preintervention) included all consecutive patients undergoing elective open UAS who met the criteria for inclusion in the study over six months (from July to December 2010) before guideline implementation (intervention). Teams of physical therapists were trained in the standardization of the new model of care during the month of January 2011.…”