Post-Extubation Early Ventilation Recommended for Chronic Respiratory Disorder Patients

A new study has found that early noninvasive ventilation (NVI) after extubation reduces mortality and lowers risk of respiratory failure in patients with chronic respiratory disorder.

Researchers from Hospital Clinic of Barcelona (Spain) conducted a randomized controlled study that enrolled 106 mechanically ventilated patients with chronic respiratory disorders and hypercapnia from three intensive-care units in Spain. Following extubation, the patients received either NVI for 24 hours (54 patients) or conventional oxygen treatment (52). The primary endpoint was avoidance of respiratory failure within 72 hours after extubation.

The researchers found that those patients given early NVI after extubation had a lower risk of death and respiratory failure than those given normal oxygen therapy. NVI was associated with an 83% decreased risk of respiratory failure after extubation, a reduction independent from other potential confounding factors. Respiratory failure after extubation was less frequent in the patients that were assigned to NVI (15%) than in those allocated conventional oxygen therapy (48%); in patients with respiratory failure, NVI as rescue therapy avoided reintubation in 17 of 27 patients. Additionally, 90-day mortality was lower in the patients assigned to NVI (11%) than in those allocated to conventional oxygen (31%). The study was published early online in the August 12, 2009, edition of the Lancet.

"Early noninvasive ventilation after extubation diminished risk of respiratory failure and lowered 90-day mortality in patients with hypercapnia during a spontaneous breathing trial,” concluded lead author Miquel Ferrer, M.D., and colleagues of the thorax clinical unit. "Routine implementation of this strategy for management of mechanically ventilated patients with chronic respiratory disorders is advisable.”

NVI is the provision of ventilation support through the patient's upper airway using a mask or similar device. A slightly pressurized airflow is blown into the mask while breathing; the strength of the pressure varies during the breathing cycle. The airflow is strongest during inspiration, helping to take in as much air as possible; airflow pressure is lower during exhalation, but remains positive. This continual positive pressure helps to ‘splint' the airways open, enabling more air to get in and out of the lungs. The system is also known as BIPAP (bilevel positive airway pressure).

Related Links:
Hospital Clínic of Barcelona