What is the role of noninvasive ventilation (NIV) after extubation?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Interest in the use of noninvasive ventilation (NIV) after discontinuation of mechanical ventilation is considerable. Postextubation respiratory insufficiency requiring reintubation can occur in more than 20% of patients. Many of the pathophysiologic derangements discussed in earlier sections also occur in the postextubation period, including increased respiratory load, hyperinflation, diaphragmatic dysfunction, and increases in preload and afterload, all of which can contribute singly or in unison to hypercapnia, hypoxemia, and eventual respiratory failure. In addition, patients may have incurred some upper airway trauma with intubation or may have developed upper airway edema, which, in turn, can contribute to partial upper airway obstruction, which is another factor contributing to an increased respiratory workload.

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