Which patients are the best candidates for 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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Answer

Answer

Overall, experience to date suggests that NIV can help facilitate weaning and discontinuation of mechanical ventilation in selected patients. Patients with underlying COPD are the best candidates, but other groups may also benefit from an early-extubation approach followed by NIV support. COPD patients who develop respiratory distress after meeting criteria for extubation are most likely to benefit from NIV, but this is not established and use of NIV in these patients (as well as any other patient who develops postextubation respiratory distress) should be done with caution. There are better outcomes with NIV provided as prophylactic or preemptive ventilatory support after extubation, but before the development of respiratory distress. For those who may not be able to tolerate NIV interfaces, HFNC oxygen is an acceptable alternative and in those patients with underlying cardiac and/or respiratory disease, the combination of NIV and HFNC oxygen reduces the incidence of postextubation respiratory failure and need for reintubation.


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