Non-invasive Ventilation Trumps Other Weaning Methods

Chronic hypercapnic respiratory failure patients have less risk of reintubation and death using noninvasive ventilation

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients with chronic obstructive pulmonary disease (COPD) may also suffer from chronic hypercapnic respiratory failure (CHRF).

Researchers in France found that patients weaned from ventilation by noninvasive ventilation (NIV) experience less incidence of additional acute respiratory failure (ARF), reintubation and may have shorter intubation times. Additionally, NIV can significantly reduce risk of death.

"NIV weaning from intubation allows a shorter weaning period with less incidence of ARF."

Lead investigator Christophe Girault, MD notes that while NIV as a weaning technique didn't preclude reintubation compared to conventional weaning and oxygen therapy, it did reduce the risk of reintubation or death with NIV. The study results indicate that NIV may be useful to avoid reintubation when post-extubation ARF occurs in patients.

Girault says that NIV also did not  increase the risk of weaning failure in terms of reintubation. Girault surmises that NIV might actually allow earlier extubation, but not more rapidly ‘de-ventilation’ in hard to extubate CHRF patients.

These results corroborate previously published results involving CHRF patients considered to be potentially difficult to extubate.

Researchers recruited 388 patients with CHRF from 13 intensive care units (ICUs) who had been intubated for at least 48 hours prior to extubation and failed a spontaneous breathing trial (SBT). Nearly 33% of the patients were able to breathe on their own after extubation.

The remaining 208 patients who failed the SBT were randomly placed in three different therapy groups:  conventional weaning, extubation followed by standard oxygen therapy using either nasal cannula or venturi mask, or extubation followed by NIV administered through a facial mask.

The three methods were evaluation by the following criteria: incidence of reintubation within a week of extubation, an additional  episode of acute respiratory failure within a week, or death within a week. Factors also considered include ICU and hospital length of stay and overall respiratory condition at the time of discharge.

The study found no significant difference between the three therapies regarding reintubation and causes of reintubation. They did find that the post-intubation acute respiratory failure occurrence was much lower in the group that had the NIV therapy post extubation. Girault observes that the NIV method of weaning allowed for a shorter intubation term without increasing the risk of reintubation. NIV may allow earlier extubation.

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Review Date: 
June 8, 2011
Last Updated:
June 14, 2011