Comparative Study Between The Efficacy Of Non-Invasive Ventilation At The Pulmonary Infection Control Window, And Spontaneous Breathing Trials As Strategies For Weaning Invasive Ventilation In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Caused By Pulmonary Infection

Abstract

Applying non-invasive positive pressure ventilation (NPPV) has been used for years in clinical practice during weaning of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), in order to avoid complications of invasive ventilation. Nevertheless, the choice of the optimal timing to apply NPPV in exacerbations caused by pulmonary infections, and whether its use would provide benefit over conventional weaning strategies, remain an issue requiring further investigations. Aim of the work: To examine the efficacy of implementing Pulmonary Infection Control (PIC) window as the optimum switching point to wean invasive mechanical ventilation (IMV) in intubated patients for AECOPD with pulmonary infection, compared to conventional weaning strategies implementing the use of Spontaneous Breathing Trials (SBT). Methods: In our prospective randomized controlled study, we enrolled the included patients to two groups, where Group A patients were extubated at the PIC window and immediately received NPPV, while Group B patients were weaned according to the conventional criteria for weaning and were granted an SBT then were extubated and received venturi oxygen therapy. All patients were monitored for forty eight hours post-extubation through assessment and documentation of certain parameters at specific checkpoints, and accordingly the success and failure rates of both weaning strategies were decided, along with the predetermined secondary outcomes of the study. Results: 65 patients who were enrolled in the study. Of the 31 patients (47.7 %) who represent Group A, 27 patients (87%) were successfully weaned, and 4 patients (13%) developed respiratory distress within the 48 hours post-extubation and were re-intubated. Two of these patients were diagnosed with ventilator-associated pneumonia (VAP). Of the other 34 patients (52.3%) representing Group B, 15 patients (44 %) experienced successful weaning, while the other 19 patients (56 %) developed respiratory distress and received NPPV. 8 patients were diagnosed with VAP and 7 of them failed to respond to NPPV within the 48 hours post-extubation, and were re-intubated. Conclusion: Based on the higher rate of successful weaning, shorter duration of invasive ventilation, shorter ICU length of stay and lower incidence of VAP, implementation of the PIC window as an optimal switching point for application of NPPV during weaning of IMV, has proven to be a more promising weaning modality than conventional weaning strategies.