Ventilation & weaning · Preventing post-extubation failure
Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Non-invasive ventilation started immediately after extubation |
| Control | Conventional oxygen therapy |
| Population | 106 patients with chronic respiratory disorders who were hypercapnic during their spontaneous breathing trial |
| Follow-up | 90 days |
| Primary endpoint | Respiratory failure after extubation |
| Result | Respiratory failure after extubation occurred in 8 of 54 (15%) with non-invasive ventilation versus 25 of 52 (48%) with oxygen — odds ratio 5.32 (95% CI 2.11 to 13.46, p<0.0001). Used as rescue therapy in those who failed, non-invasive ventilation avoided reintubation in 17 of 27. Ninety-day mortality was lower with prophylactic non-invasive ventilation. |
| Secondary endpoints | Reintubation, 90-day mortality, ICU and hospital stay |
Early non-invasive ventilation after extubation diminished risk of respiratory failure and lowered 90-day mortality in patients with hypercapnia during a spontaneous breathing trial. Routine implementation of this strategy for management of mechanically ventilated patients with chronic respiratory disorders is advisable.
The trial authors, in the published abstract
Selection is everything in the post-extubation literature. This trial picked hypercapnic patients with chronic lung disease and found a mortality benefit; Esteban 2004 took unselected patients already in failure and found none. Prophylaxis in the right group, not rescue in everyone.
Ferrer M, Sellarés J, Valencia M, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009 Sep 26;374(9695):1082-8.