title: Noninvasive ventilation during persistent weaning failure: a randomized controlled trial.
abstract: To assess the efficacy of noninvasive ventilation (NIV) in patients with persistent weaning failure, we conducted a prospective, randomized, controlled trial in 43 mechanically ventilated patients who had failed a weaning trial for 3 consecutive days. This trial was stopped after a planned interim analysis. Patients were randomly extubated, receiving NIV (n = 21), or remained intubated following a conventional-weaning approach consisting of daily weaning attempts (n = 22). Compared with the conventional-weaning group, the noninvasive-ventilation group had shorter periods of invasive ventilation (through tracheal intubation) (9.5 +/- 8.3 vs. 20.1 +/- 13.1 days, p = 0.003) and intensive care unit (ICU) (14.1 +/- 9.2 vs. 25.0 +/- 12.5 days, p = 0.002) and hospital stays (27.8 +/- 14.6 vs. 40.8 +/- 21.4 days, p = 0.026), less need for tracheotomy to withdraw ventilation (1, 5% vs. 13, 59%, p < 0.001), lower incidence of nosocomial pneumonia (5, 24% vs. 13, 59%, p = 0.042) and septic shock (2, 10% vs. 9, 41%, p = 0.045), and increased ICU (19, 90% vs. 13, 59%, p = 0.045) and 90-day survival (p = 0.044). The conventional-weaning approach was an independent risk factor of decreased ICU (odds ratio: 6.6; p = 0.035) and 90-day survival (odds ratio: 3.5; p = 0.018). Earlier extubation with NIV results in shorter mechanical ventilation and length of stay, less need for tracheotomy, lower incidence of complications, and improved survival in these patients.
authors.affiliation: UVIR, Institut Clinic de Pneumologia i Cirurgia Toracica, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. miferrer@clinic.ub.es
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Antonio
authors.initials: A
authors.lastname: Esquinas
authors.forename: Francisco
authors.initials: F
authors.lastname: Arancibia
authors.forename: Torsten Thomas
authors.initials: TT
authors.lastname: Bauer
authors.forename: Gumersindo
authors.initials: G
authors.lastname: Gonzalez
authors.forename: Andres
authors.initials: A
authors.lastname: Carrillo
authors.forename: Robert
authors.initials: R
authors.lastname: Rodriguez-Roisin
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008397:Masks; D011014:Pneumonia / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D014140:Tracheotomy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*