Noninvasive ventilation for prevention of postextubation 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 Veterans Affairs Medical Center

^* To whom correspondence should be addressed. E-mail: solh{at}buffalo.edu.

	Abstract

Current recommendations for management of obese patients post extubation are based on clinical experience and expert opinions. We hypothesized that application of noninvasive ventilation during the first 48 hours after extubation in severely obese patients would reduce postextubation failure and avert the need for reintubation.

Following protocol-driven weaning trials, sixty two consecutive severely obese patients (BMI35 kg·m^-2) were assigned to noninvasive ventilation (NIV) via nasal mask immediately post extubation and compared to 62 historically matched controls who were treated with conventional therapy. The primary end point was the incidence of respiratory failure in the first 48 hours post extubation.

Compared to 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 ICU and hospital lengths of stay between the two groups (p<0.001 and p=0.007; respectively). Subgroup analysis of hypercapnic patients showed a reduced hospital mortality in the NIV group compared to the control group (p=0.02).

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

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