Effect of Post-Extubation Noninvasive Ventilation on Weaning Outcomes in Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease

Abstract

Mechanical ventilation is a daily event in any ICU, using NIV as a weaning facilitating strategy for mechanically ventilated patients after passing Spontaneous Breathing Trial (SBT) recently considered to reduce complications associated with invasive ventilation. Also NIV used early to avoid invasive ventilation especially with COPD patients. In our performed study we applied NIV for mechanically ventilated patients ≥ 72 hrs. immediately after planned extubation compared to conventional face mask regarding ICU stay, hospital mortality, reintubation rate. Fifty patients were randomized to two groups 25 patients each, NIV group assigned to apply NIV while FM group assigned to face mask. The weaning protocol was based on a gradual reduction of pressure-support ventilation mode (PSV) combined with synchronized intermittent mandatory ventilation (SIMV). The adjustments of the mechanical ventilator were as follows: PSV to obtain an expiratory tidal volume of 8 ml/kg; SIMV with a respiratory rate of 10 and a tidal volume of 8 ml/kg, FIO2 ≤ 40%, PEEP required to obtain SaO2≥ 90%, and pressure sensitivity of 0.5 cm H2O. The pressure-support level was decreased by 2 cm H2O every 2 hours until a PSV of 10 cm H2O was reached. If f/TV >105, PSV was increased to the previous value for a minimum period of 6 hours, after which the protocol was