Non-invasive ventilation as a weaning tool.
Patients with chronic airflow obstruction and difficult weaning from mechanical ventilation are at increased risk for intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Non-invasive positive-pressure ventilation (NPPV) may revert most of the pathophysiologic mechanisms associated with weaning failure in these patients. Several randomised controlled trials have shown that the use of NPPV in order to advance extubation in difficult to wean patients can result in reduced periods of endotracheal intubation, complication rates and survival. The published data with outcome as a primary variable is nearly exclusively from patients who had pre-existing lung disease. In addition the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether NPPV has a role in other patients' groups and situations. The technique is however a usual addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.
Ferrer
M
M
Respiratory Intensive and Intermediate Care Unit, Department of Pneumology, Hospital Clínic, IDIBAPS, Barcelona, Spain. miferrer@clinic.ub.es
D006801:Humans; D012121:Respiration, Artificial / Q000009:adverse effects; D017211:Treatment Failure; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*