title: Preventive use of noninvasive ventilation after extubation: a prospective, multicenter randomized controlled trial.
abstract: BACKGROUND
  The effectiveness of noninvasive ventilation (NIV) after extubation in preventing post-extubation respiratory failure is still controversial.
  
  
  METHODS
  We conducted a prospective, multicenter randomized controlled study involving patients on mechanical ventilation for >  48 hours who tolerated a 2-hour spontaneous breathing trial and were subsequently extubated. The patients were randomized to NIV or standard medical therapy. Re-intubation rate within 72 hours was the primary outcome measure. Multivariable logistic regression analysis was used to determine  predictors for extubation failure.
  
  
  RESULTS
  We randomized 406 patients to either NIV (no. = 202) or standard medical therapy (no. = 204). The 2 groups had similar baseline clinical characteristics. There were no differences in extubation failure (13.2% in control and 14.9% in NIV), intensive  care unit or hospital mortality. Cardiac failure was a more common cause of extubation failure in control than in NIV. There was no difference in rapid shallow breathing index (RSBI) in extubation failure patients between control (80) and NIV (73). When using data from all patients, we found  Acute Physiology and Chronic Health Evaluation (APACHE II) scores (odds ratio [OR] 1.13, 95% CI 1.07-1.20, P < .001), maximal inspiratory pressure (OR 1.04, 95% CI 1.00-1.08, P = .03), and RSBI (OR 1.03, 95% CI 1.02-1.05, P < .001) to be predictors  of extubation failure. Abundant secretions were the most common reason (35.1%) for extubation failure identified by attending physicians.
  
  
  CONCLUSIONS
  Preventive use of NIV after extubation in patients who passed spontaneous breathing trial did not show benefits in decreasing extubation failure  rate or the mortality rate.
authors.affiliation: School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chien-Ling
authors.initials: CL
authors.lastname: Su
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Chiang
authors.forename: Shih-Hsing
authors.initials: SH
authors.lastname: Yang
authors.forename: Hen-I
authors.initials: HI
authors.lastname: Lin
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.forename: Yuh-Chin T
authors.initials: YC
authors.lastname: Huang
authors.forename: Chin-Pyng
authors.initials: CP
authors.lastname: Wu
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011175:Positive-Pressure Respiration / Q000379:methods*; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D015300:Ventilator Weaning / Q000009:adverse effects* / Q000379:methods