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Critical Care

, 12:R51

First Online: 17 April 2008Received: 02 August 2007Revised: 23 January 2008Accepted: 17 April 2008


IntroductionThe use of noninvasive positive-pressure mechanical ventilation NPPV has been investigated in several acute respiratory failure situations. Questions remain about its benefits when used in weaning patients from invasive mechanical ventilation IMV. The objective of this study was to evaluate the use of bi-level NPPV for patients who fail weaning from IMV.

MethodsThis experimental randomized clinical trial followed up patients undergoing IMV weaning, under ventilation for more than 48 hours, and who failed a 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 IMV 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 30 minutes. After failing a T-piece trial, patients were randomly divided in two groups: a those who were extubated and placed on NPPV and b those who were returned to IMV. Group results were compared using the Student t test and the chi-square test.

ResultsOf 65 patients who failed T-piece trials, 28 were placed on NPPV and 37 were placed on IMV. The ages of patients in the NPPV and IMV groups were 67.6 ± 15.5 and 59.7 ± 17.6 years, respectively. Heart disease, post-surgery respiratory failure, and chronic pulmonary disease aggravation were the most frequent causes of IMV use. In both groups, ventilation time before T-piece trial was 7.3 ± 4.1 days. Heart and respiratory parameters were similar for the two groups at 1 and 30 minutes of T-piece trial. The percentage of complications in the NPPV group was lower 28.6% versus 75.7%, with lower incidences of pneumonia and tracheotomy. Length of stay in the intensive care unit and mortality were not statistically different when comparing the groups.

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

Trial registrationCEP HCPA 02–114.

AbbreviationsARFacute respiratory failure

bpmbeats per minute

COPDchronic obstructive pulmonary disease

CPISclinical pulmonary infection score

DBPdiastolic blood pressure

FiO2 fraction of inspired oxygen

HRheart rate

ICUintensive care unit

IMVinvasive mechanical ventilation

MODSmultiple organ dysfunction syndrome

NPPVnoninvasive positive-pressure mechanical ventilation

PaCO2arterial partial pressure of carbon dioxide

PaO2arterial partial pressure of oxygen

PEEPpositive end-expiratory pressure

PImaxmaximal inspiratory pressure

PTPdidiaphragmatic pressure-time product

frespiratory rate

f-VTrespiratory rate to tidal volume ratio

SBPsystolic blood pressure

SBTspontaneous breathing T-piece trial

SIRSsystemic inflammatory response syndrome

SpO2peripheral oxygen saturation

Veminute volume

VTtidal volume.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6870 contains supplementary material, which is available to authorized users.

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Autor: Cristiane E Trevisan - Silvia R Vieira - the Research Group in Mechanical Ventilation Weaning


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