Noninvasive Ventilation during Persistent Weaning Failure
- 1 July 2003
- journal article
- clinical trial
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 168 (1), 70-76
- https://doi.org/10.1164/rccm.200209-1074oc
Abstract
To assess the efficacy of noninvasive ventilation (NIV) in patients with persistent weaning failure, we conducted a prospective, randomized, controlled trial in 43 mechanically ventilated patients who had failed a weaning trial for 3 consecutive days. This trial was stopped after a planned interim analysis. Patients were randomly extubated, receiving NIV (n = 21), or remained intubated following a conventional-weaning approach consisting of daily weaning attempts (n = 22). Compared with the conventional-weaning group, the noninvasive-ventilation group had shorter periods of invasive ventilation (through tracheal intubation) (9.5 +/- 8.3 vs. 20.1 +/- 13.1 days, p = 0.003) and intensive care unit (ICU) (14.1 +/- 9.2 vs. 25.0 +/- 12.5 days, p = 0.002) and hospital stays (27.8 +/- 14.6 vs. 40.8 +/- 21.4 days, p = 0.026), less need for tracheotomy to withdraw ventilation (1, 5% vs. 13, 59%, p < 0.001), lower incidence of nosocomial pneumonia (5, 24% vs. 13, 59%, p = 0.042) and septic shock (2, 10% vs. 9, 41%, p = 0.045), and increased ICU (19, 90% vs. 13, 59%, p = 0.045) and 90-day survival (p = 0.044). The conventional-weaning approach was an independent risk factor of decreased ICU (odds ratio: 6.6; p = 0.035) and 90-day survival (odds ratio: 3.5; p = 0.018). Earlier extubation with NIV results in shorter mechanical ventilation and length of stay, less need for tracheotomy, lower incidence of complications, and improved survival in these patients.Keywords
This publication has 36 references indexed in Scilit:
- Ventilator-associated PneumoniaAmerican Journal of Respiratory and Critical Care Medicine, 2002
- Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: A prospective case-control studyCritical Care Medicine, 2001
- The Occurrence of Ventilator-Associated Pneumonia in a Community HospitalChest, 2001
- Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trialThe Lancet, 1999
- Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory FailureAmerican Journal of Respiratory and Critical Care Medicine, 1999
- Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary DiseaseAnnals of Internal Medicine, 1998
- Modes of Mechanical Ventilation and WeaningChest, 1994
- Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 daysEuropean Respiratory Journal, 1994
- Incidence, Risk, and Prognosis Factors of Nosocomial Pneumonia in Mechanically Ventilated PatientsAmerican Review of Respiratory Disease, 1990
- Nosocomial PneumoniaChest, 1988