What is the efficacy of postextubation noninvasive ventilation (NIV) support?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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A systematic review and meta-analyses of noninvasive ventilation and weaning in slightly more than 500 patients (mostly COPD patients) found that the use of noninvasive ventilation reduced mortality rates by 45% (RR, 0.55; 95% CI, 0.38-0.79), ventilator-associated pneumonia rates by 71% (RR, 0.29; 95% CI, 0.19-0.45), weighted duration of ICU stay by 6.27 days (95% CI, 8.77-3.78 d), and hospital days by 7.19 days (10.8-3.58 d) compared with a conventional weaning approach. The duration of endotracheal intubation was reduced by 7.81 days (95% CI, 11.3-4.31 d), as was the need for tracheostomy. However, reintubation rates were not decreased. [28] A more recent report suggests that hypercapnic patients may fare better if treated with noninvasive ventilation following extubation. [29]

These results conflict with reports of increased adverse outcomes (reintubation, mortality) when noninvasive ventilation is applied later in the course of patients on mechanical ventilation, after they have fulfilled criteria for extubation, are extubated, and develop respiratory distress. Noteworthy is that only approximately 10% of the patients in these trials had COPD, and this is the group that seemed to benefit the most from noninvasive ventilation. [30] On the other hand, in a smaller prospective randomized trial of 97 high-risk patients with mixed causes of respiratory failure including COPD, ARDS, and pneumonia, application of NIV 1 hour after extubation was associated with a lower reintubation rate (8.3 % vs 24.5%, P = .027). [31]

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