Thursday, April 17, 2008

Thursday April 17, 2008
NIPPV for patients that fail weaning from invasive mechanical ventilation?

Very interesting study, just published today !!


The objective of this study was to evaluate the use of bi-level noninvasive positive-pressure mechanical ventilation (NPPV) for patients that fail weaning from invasive mechanical ventilation (IMV).

Methods: This experimental randomized clinical trial followed up patients undergoing IMV weaning, under ventilation for more than 48 hours, and who failed spontaneous breathing T-piece trial. Patients with contraindications to NPPV were excluded. Before T-piece placement, arterial gases, maximal inspiratory pressure, and other parameters of invasive mechanical ventilation support were measured. During the trial, respiratory rate, tidal volume, minute volume, rapid shallow breathing index, heart rate, arterial blood pressure, and peripheral oxygen saturation were measured at 1 and at 30 minutes. After failing T-piece trial, patients were randomly divided in two groups:

patients were extubated and placed on NPPV
patients returned to IMV

Results: Of 65 patients that failed T-piece trials, 28 were placed on NPPV and 37 on IMV

  • The percentage of complications in the NPPV group was lower (28.6% vs. 75.7%), with lower incidence of pneumonia and tracheotomy.
  • Length of stay in the intensive care unit and mortality were not statistically different when comparing the groups.

Conclusions: Results suggest that NPPV is a good alternative for ventilation of patients that fail initial weaning attempts. NPPV reduces the incidence of pneumonia associated with mechanical ventilation and the need for tracheotomy.

Reference: click to get article


Noninvasive mechanical ventilation may be useful in treating patients that fail weaning from invasive mechanical ventilation: a randomized clinical trial -Critical Care 2008, 12:R51

full pdf version of article is available at site