title: Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial.
abstract: BACKGROUND
  The use of noninvasive ventilation (NIV) as an early weaning/extubation technique from mechanical ventilation remains controversial.
  
  
  OBJECTIVE
  To investigate NIV effectiveness as an early weaning/extubation technique in difficult-to-wean patients with chronic hypercapnic respiratory failure (CHRF).
  
  
  METHODS
  In 13 intensive care units, 208 patients with CHRF intubated for acute respiratory failure (ARF) who failed a first spontaneous breathing trial were randomly assigned to three groups: conventional invasive weaning group (n = 69), extubation followed by standard oxygen therapy (n = 70), or NIV (n = 69). NIV was permitted as rescue therapy for both non-NIV groups if postextubation ARF occurred. Primary endpoint was reintubation within 7 days after extubation. Secondary endpoints were: occurrence of postextubation ARF or death within 7 days after extubation, use of rescue postextubation NIV, weaning time, and patient outcomes.
  
  
  RESULTS
  Reintubation rates were 30, 37, and 32% for invasive weaning, oxygen-therapy, and NIV groups, respectively (P = 0.654). Weaning failure rates, including postextubation ARF, were 54, 71, and 33%, respectively (P < 0.001). Rescue NIV success rates for invasive and oxygen-therapy groups were 45 and 58%, respectively (P = 0.386). By design, intubation duration was 1.5 days longer for the invasive group than in the two others. Apart from a longer weaning time in NIV than in invasive group (2.5 vs. 1.5 d; P = 0.033), no significant outcome difference was observed between groups.
  
  
  CONCLUSIONS
  No difference was found in the reintubation rate between the three weaning strategies. NIV decreases the intubation duration and may improve the weaning results in difficult-to-wean patients with CHRF by reducing the risk of postextubation ARF. The benefit of rescue NIV in these patients deserves confirmation.
authors.affiliation: Department of Medical Intensive Care, Rouen University Hospital, Rouen, France. Christophe.Girault@chu-rouen.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Girault
authors.forename: Michael
authors.initials: M
authors.lastname: Bubenheim
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Diehl
authors.forename: Souheil
authors.initials: S
authors.lastname: Elatrous
authors.forename: Pascal
authors.initials: P
authors.lastname: Beuret
authors.forename: Jack
authors.initials: J
authors.lastname: Richecoeur
authors.forename: Erwan
authors.initials: E
authors.lastname: L'Her
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.forename: Mohamed
authors.initials: M
authors.lastname: Besbes
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
authors.forename: Philippe
authors.initials: P
authors.lastname: Guiot
authors.forename: Jacques
authors.initials: J
authors.lastname: Bénichou
authors.forename: Guy
authors.initials: G
authors.lastname: Bonmarchand
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods