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Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

¹ Western New York Respiratory Research Center, Depts of Medicine and of Biostatistics, Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo, and ² Veterans Affairs Medical Center, Buffalo, NY, USA.

CORRESPONDENCE: A. A. El Solh, Division of Pulmonary, Critical Care, and Sleep Medicine, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA. Fax: 1 7168986139. E-mail: solh{at}buffalo.edu

Keywords: Noninvasive ventilation, obesity, obstructive sleep apnoea, reintubation

Received: December 21, 2005
Accepted May 11, 2006

Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation.

Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index 35 kg·m^-2) were assigned to NIV via nasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation.

Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9–29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group.

In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.

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