Citation Information :
Thanthitaweewat V. Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial. Indian J Crit Care Med 2018; 22 (9):639-645.
Purpose: Till date, the benefit of using noninvasive ventilation (NIV) routinely after extubation to prevent reintubation has been conflicting. We aim to demonstrate the effect of targeted-volume NIV for the prevention of reintubation and extubation failure after planned extubation in medical intensive care unit (ICU) patients. Study Design: This was a prospective, randomized controlled study.
Materials and Methods: Patients on invasive mechanical ventilation for more than 48 hrs for acute respiratory failure, who were ready for extubation, were randomized into targeted-volume NIV (intervention group) or oxygen mask (controlled group) immediately after extubation and continuously for 24 hrs.
Results: A total of 58 patients were enrolled in this study. The targeted-volume NIV group was observed to have a trend toward lower reintubation rate within 48 hrs compared to oxygen mask group (0% vs. 17.2%; P = 0.052). Extubation failure rate within 48 hrs was significantly lower in targeted-volume NIV group compared to oxygen mask group (0% vs. 41.38%; P < 0.001). There was a trend toward lower ICU length of stay (6 days vs. 10 days (median interquartile range [IQR]); P = 0.053) as well as shorter hospital length of stay after extubation (10 days vs. 18 days (median [IQR]); P = 0.059). There were no differences in the incidence of ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (6.90% vs. 20.69%;P = 0.253) and 28 day-mortality (13.79% vs. 20.69%; P = 0.487).
Conclusions: Our study is the first study to demonstrate the benefit of application of targeted-volume NIV immediately after extubation in reducing extubation failure rate. There was a trend toward lowering reintubation rate and shorter ICU length of stay and hospital length of stay after extubation in mixed medical ICU patients.
Antonelli M, Bello G. Noninvasive mechanical ventilation during the weaning process: Facilitative, curative, or preventive? Crit Care 2008;12:136.
Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A, et al. Early noninvasive ventilation averts extubation failure in patients at risk: A randomized trial. Am J Respir Crit Care Med 2006;173:164-70.
Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33:2465-70.
Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-22.
Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008;359:142-51.
Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: A randomized controlled trial. JAMA 2005;293:589-95.
Bajaj A, Rathor P, Sehgal V, Shetty A. Efficacy of noninvasive ventilation after planned extubation: A systematic review and meta-analysis of randomized controlled trials. Heart Lung 2015;44:150-7.
Thille AW, Boissier F, Ben-Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C, et al. Easily identified at-risk patients for extubation failure may benefit from noninvasive ventilation: A prospective before-after study. Crit Care 2016;20:48.
Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tófoli LT, Vidal AM, et al. Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: A randomized controlled trial. Crit Care 2013;17:R39.
Figueroa-Casas JB. Preventive use of noninvasive ventilation after planned extubation. Respir Care 2012;57:318-20.
Su CL, Chiang LL, Yang SH, Lin HI, Cheng KC, Huang YC, et al. Preventive use of noninvasive ventilation after extubation: A prospective, multicenter randomized controlled trial. Respir Care 2012;57:204-10.
Dehaven CB Jr., Hurst JM, Branson RD. Postextubation hypoxemia treated with a continuous positive airway pressure mask. Crit Care Med 1985;13:46-8.
Lindner KH, Lotz P, Ahnefeld FW. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest 1987;92:66-70.
Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, et al. Average volume-assured pressure support in obesity hypoventilation: A randomized crossover trial. Chest 2006;130:815-21.
Janssens JP, Metzger M, Sforza E. Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation. Respir Med 2009;103:165-72.
Briones Claudett KH, Briones Claudett M, Chung Sang Wong M, Nuques Martinez A, Soto Espinoza R, Montalvo M, et al. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy. BMC Pulm Med 2013;13:12.
Cao Z, Luo Z, Hou A, Nie Q, Xie B, An X, et al. Volume-targeted versus pressure-limited noninvasive ventilation in subjects with acute hypercapnic respiratory failure: A multicenter randomized controlled trial. Respir Care 2016;61:1440-50.
Struik FM, Duiverman ML, Meijer PM, Nieuwenhuis JA, Kerstjens HA, Wijkstra PJ, et al. Volume-targeted versus pressure-targeted noninvasive ventilation in patients with chest-wall deformity: A pilot study. Respir Care 2011;56:1522-5.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.
MacIntyre NR. The ventilator discontinuation process: An expanding evidence base. Respir Care 2013;58:1074-86.
Bello G, De Pascale G, Antonelli M. Noninvasive ventilation. Clin Chest Med 2016;37:711-21.
Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, et al. Liberation from mechanical ventilation in critically ill adults: An official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest 2017;151:166-80.
Keenan SP, Powers C, McCormack DG, Block G. Noninvasive positive-pressure ventilation for postextubation respiratory distress: A randomized controlled trial. JAMA 2002;287:3238-44.
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452-60.
Tulaimat A, Gueret RM, Wisniewski MF, Samuel J. Association between rating of respiratory distress and vital signs, severity of illness, intubation, and mortality in acutely ill subjects. Respir Care 2014;59:1338-44.
Carteaux G, Millán-Guilarte T, De Prost N, Razazi K, Abid S, Thille AW, et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: Role of tidal volume. Crit Care Med 2016;44:282-90.
Girault C, Ferrer M, Torres A. Non-invasive ventilation in hypoxemic acute respiratory failure: Is it still possible? Intensive Care Med 2017;43:243-5.
Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish lung failure collaborative group. Am J Respir Crit Care Med 1997;156:459-65.
Burns KE, Adhikari NK, Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth 2006;53:305-15.
Epstein SK. Extubation. Respir Care 2002;47:483-92.
Epstein SK. Decision to extubate. Intensive Care Med 2002;28:535-46.
Hess DR. The role of noninvasive ventilation in the ventilator discontinuation process. Respir Care 2012;57:1619-25.
Girault C, Bubenheim M, Abroug F, Diehl JL, Elatrous S, Beuret P, et al. Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: A randomized multicenter trial. Am J Respir Crit Care Med 2011;184:672-9.