Source: Annual Congress 2008 - Progress and a new era for noninvasive mechanical ventilation
Disease area: Airway diseases, Respiratory critical care

Abstract

Background. Patients with hypercapnia after withdrawal of mechanical ventilation have poor outcome. NIV avoided respiratory failure after extubation (RFAE) and suggested an improved survival in hypercapnic patients (AJRCCM 2006;173:164-70). We prospectively assessed the efficacy of NIV after extubation in hypercapnic patients and as a rescue therapy when RFAE develops.
Methods. A randomized controlled trial was conducted in 106 mechanically-ventilated patients with chronic respiratory disorders and hypercapnia during a successful spontaneous breathing trial. Patients were allocated after extubation to receive NIV for 24 hours (n= 54) or conventional oxygen therapy (control group, n=52). The primary end-point variable was avoidance of respiratory failure after extubation.
Results. The main cause for intubation was exacerbation of chronic respiratory disorder (53, 50%). RFAE was less frequent in the NIV group (8, 15% vs 25, 48%, p<0.001). In patients with RFAE and no need for immediate re-intubation, NIV as rescue therapy avoided re-intubation in 17 of 27 patients; the remaining met criteria for re-intubation. The length of stay and hospital survival did not change, but 90-day survival was higher (p=0.015) in the NIV group. NIV was independently associated to lower risk for RFAE.
Conclusion. Early NIV after extubation avoided re-intubation and improved survival in patients with hypercapnia during a spontaneous breathing trial. This strategy should be routinely implemented in the clinical management of ventilated patients with chronic respiratory disorders.
Funded By: FIS 04/1130, CibeRes (CB06/06/0028), 2005 SGR 00822, and ERS Fellowship.

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M. Ferrer, M. Valencia, J. Sellares, A. Carrillo, G. Gonzalez, J. R. Badia, R. Piñer, C. Esquinas, J. M. Nicolas, A. Torres (Barcelona, Murcia, Spain). Non-invasive ventilation (NIV) after extubation in hypercapnic patients with chronic respiratory disorders: a randomized trial. Eur Respir J 2008; 32: Suppl. 52, 359

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