Noninvasive Ventilation May Cut Risks in Some Patients

Noninvasive ventilation (NIV), when used as a weaning technique in mechanically ventilated patients, can shorten intubation time and reduce the risk of postextubation acute respiratory failure (ARF), according to a new study.

Researchers at Rouen University Hospital (France) consecutively recruited 388 patients with chronic hypercapnic respiratory failure (CHRF) from 13 French and Tunisian ICUs between January 2002 and March 2006. Eligible patients had to have been intubated for at least 48 hours and failed a spontaneous breathing trial (SBT). The 208 patients that failed the SBT were randomized to one of three ventilation-weaning strategies; conventional weaning, where patients remained intubated and underwent one or more daily SBT with T-piece or pressure support ventilation (PSV) with or without positive end expiratory pressure (PEEP), and a progressive decrease in PSV level; extubation followed by standard oxygen therapy-administered via a nasal cannula or venturi mask; or extubation followed by NIV administered through a facial mask.

The primary endpoint evaluated was the need for reintubation within seven days of extubation; secondary endpoints were secondary occurrence of ARF or death from all causes within seven days of extubation. The researchers also evaluated time to rescue post-extubation NIV and the probability of reintubation or death within seven days following its initiation; ICU and hospital length of stay and survival; and respiratory condition on hospital discharge. The results showed that the probability of reintubation was not significantly different between the three weaning strategies, and that the causes of reintubation were similar between groups. However, postintubation ARF in the NIV group was significantly lower than in others. The study was published online ahead of print on June 9, 2011, in the American Journal of Respiratory and Critical Care Medicine.

"While NIV used as a weaning technique did not reduce the risk of reintubation as compared with conventional weaning and standard oxygen therapy, we do think the reduced risk of reintubation or death with NIV used as rescue therapy bears further investigation," concluded lead author Christophe Girault, MD. "NIV allowed to decrease the intubation duration as compared to invasive weaning, without increasing the risk of weaning failure in terms of reintubation."

NIV refers to all modalities that assist ventilation without the use of an endotracheal tube. It is primarily aimed at minimizing patient discomfort and the complications associated with invasive ventilation. It is often used in cardiac disease, exacerbations of chronic pulmonary disease (CPD), sleep apnea, and neuromuscular diseases. NIV refers only to the patient interface and not the mode of ventilation used; modes may include spontaneous or control modes and may be either pressure or volume modes.

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Rouen University Hospital