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Noninvasive ventilation after intubation and mechanical ventilation

¹ Respiratory Intensive Care Unit, Unit of Pneumology, Clinical Institute of Pneumology and Thoracic Surgery, University of Barcelona, Barcelona, Spain. ² Respiratory Intensive Care Unit, S. Maugeri Foundation, Scientific and Care Institution, Scientific Institute of Pavia, Pavia, Italy

CORRESPONDENCE: M. Ferrer, UVIR, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain. Fax: 34 932275454. E-mail: miferrer@clinic.ub.es

Keywords: intensive care unit, mechanical ventilation, noninvasive ventilation, weaning

Received: February 12, 2001
Accepted December 3, 2001

This study was supported by grant No. 1999 SGR 00228 from the Department of Universities and Research, Generalitat of Catalonia, Catalonia, Spain, and the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain.

Abstract

Patients with chronic airflow obstruction who are difficult to wean from mechanical ventilation are at increased risk of intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Noninvasive positive pressure ventilation may revert most of the pathophysiological mechanisms associated with weaning failure in these patients.

Several randomized controlled trials have shown that use of noninvasive ventilation to achieve earlier extubation in difficult-to-wean patients or in patients who develop respiratory failure after apparently successful extubation can result in reduced periods of endotracheal intubation and complication rates and improved survival. However, this is not a consistent finding, and the currently available published data with outcome as the primary variable are exclusively from patients who had pre-existing lung disease. In addition, the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex.

It remains to be seen whether noninvasive positive pressure ventilation has a role in other patient groups and situations, such as prevention of postextubation failure or unplanned extubation. The technique is, however, a useful addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.

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				M. W. Elliott Non-invasive ventilation for acute respiratory disease Br. Med. Bull., March 31, 2005; 72(1): 83 - 97. [Abstract] [Full Text] [PDF]