Respiratory Trials·org

Topic

Ventilation & weaning

Oxygen targets, non-invasive support, high-flow oxygen, extubation, and tracheostomy.

Non-invasive ventilation earns its place in hypercapnic COPD and almost nowhere else with the same confidence. In acute exacerbations it reduced intubation, length of stay and in-hospital mortality (Brochard 1995). In cardiogenic pulmonary oedema it relieves distress and acidosis faster than oxygen but does not reduce mortality (3CPO) — a distinction worth keeping straight.

High-flow nasal oxygen did not reduce intubation in hypoxaemic respiratory failure, its primary endpoint, but produced more ventilator-free days and lower 90-day mortality as secondary findings (FLORALI). The non-invasive ventilation arm fared worst of the three, which is the part of that trial most often forgotten.

Liberation is about sedation as much as ventilation. Pairing a daily spontaneous awakening trial with a daily breathing trial produced more ventilator-free days and better one-year survival than breathing trials alone (Wake up and breathe). How the breathing trial itself is conducted matters less: pressure support and T-piece gave identical ventilator-free days (TIP-EX).

Weaning from the ventilator

Trial Year Therapy Effect Finding
TIP-EX 2022 Pressure-support spontaneous breathing trial Pressure support and T-piece breathing trials produced the same ventilator-free days
Wake up and breathe 2008 Paired sedation interruption and breathing trial Pairing daily sedation interruption with a breathing trial got patients off ventilators sooner and improved survival

High-flow nasal oxygen

Trial Year Therapy Effect Finding
FLORALI 2015 High-flow nasal oxygen High-flow oxygen did not reduce intubation but was associated with lower 90-day mortality

Non-invasive support in cardiogenic pulmonary oedema

Trial Year Therapy Effect Finding
3CPO 2008 CPAP or bilevel NIV Non-invasive ventilation made patients with pulmonary oedema feel better faster without saving lives

Non-invasive ventilation in COPD exacerbation

Trial Year Therapy Effect Finding
Brochard 1995 1995 Non-invasive ventilation Non-invasive ventilation cut intubation, length of stay and mortality in COPD exacerbations

Key references

Guidelines, standards and reviews for this topic.

Studies not yet summarised

On the reading list for this topic and awaiting a full record. Listed here so nothing is hidden.