Noninvasive Ventilation in Withdrawal from Mechanical Ventilation

Abstract

Patients with chronic airflow obstruction and difficult or prolonged weaning are at increased risk for prolonged invasive mechanical ventilation (IMV). Several randomized controlled trials mainly conducted in patients who had pre-existing lung disease have shown that the use of noninvasive ventilation (NIV) to advance extubation in patients with difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates, and improved survival. Patients in these studies were hemodynamically stable, with a normal level of consciousness, no fever, and a preserved cough reflex. The use of NIV in the management of mixed populations with respiratory failure after extubation, including small proportions of chronic respiratory patients did not show clinical benefits included. By contrast, 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 comorbidity, and hypercapnic respiratory failure. Finally, both continuous positive airway pressure and NIV can improve clinical outcomes in patients with postoperative acute respiratory failure, particularly abdominal and thoracic surgery.

Keywords

noninvasive ventilation - difficult weaning - prolonged weaning - respiratory failure after extubation - postoperative respiratory failure

Note

This study was supported by Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-Instituto de Salud Carlos III (ISCiii), 2009 SGR 911, and Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).

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