Ventilation & weaning · Rescuing established post-extubation failure
Noninvasive positive-pressure ventilation for respiratory failure after extubation
| Design | Multicentre randomised trial, stopped early after interim analysis |
|---|---|
| Treatment | Non-invasive positive-pressure ventilation |
| Control | Standard medical therapy |
| Population | 221 unselected patients who developed respiratory failure after extubation |
| Follow-up | ICU stay |
| Primary endpoint | Need for reintubation |
| Result | Reintubation was needed in 48% of both groups (relative risk with non-invasive ventilation 0.99, 95% CI 0.76 to 1.30). ICU mortality was higher with non-invasive ventilation, 25% versus 14% (relative risk 1.78, 95% CI 1.03 to 3.20, p=0.048), and median time from respiratory failure to reintubation was longer, 12 versus 2.5 hours (p=0.02). The trial was stopped early. |
| Secondary endpoints | ICU mortality, time from failure to reintubation |
Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have respiratory failure after extubation.
The trial authors, in the published abstract
The reason non-invasive ventilation is used to prevent post-extubation failure rather than to treat it. Time spent on a mask while deteriorating is time not spent intubated, and that delay is the plausible mechanism of harm. Compare Ferrer 2009, which applied it prophylactically to a selected group and found benefit.
Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004 Jun 10;350(24):2452-60.