RT Journal Article
SR Electronic
T1 Noninvasive ventilation in the weaning of patients with acute-on-chronic respiratory failure due to COPD
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p3785
VO 38
IS Suppl 55
A1 Gamal Agmy
A1 Yasser Gad
A1 Yossef Ahmed
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p3785.abstract
AB Background: Endotracheal intubation (ETI) and mechanical ventilation are often needed in patients with acute-on-chronic respiratory failure (ACRF) due to acute exacerbations of COPD (AECOPD).Purpose: It was to assess the usefulness of non invasive ventilation as an early extubation and weaning technique in ACRF secondary to AECOPD.Patients and methods: Among 384 consecutively intubated patients admitted for ACRF due to AECOPD, a prospective, randomized controlled trial of weaning was conducted in 264 patients who failed a 2-h spontaneous breathing trial, although they met simple cri-teria for weaning. Conventional invasive pressure support ventilation (IPSV) was used as the control weaning technique in 130 patients (IPSV group), and NIV was applied immediately after extubation in 134 patients (NIV group).Results: No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 100 of 130 patients were successfully weaned and extubated, versus 124 of 134 in the NIV group (p <0.05). NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during a 2-h spontaneous breathing trial (p < 0.05). The duration of ETI was significantly shorter in the NIV (4.52±0.87 d) than in the IPSV group (7.06±1.32 d) (p < 0.001). NIV reduced significantly the duration of ETI, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.Conclusions: 1. NIV like IPSV significantly and similarly improves gas exchange during weaning, of patients with ACRF secondary to AECOPD, from invasive MV. 2. NIV reduces significantly the duration of ETI, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.