title: Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients.
abstract: BACKGROUND
  Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation.
  
  
  METHODS
  We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days.
  
  
  RESULTS
  The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01).
  
  
  CONCLUSIONS
  The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.
authors.affiliation: Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Nery
authors.forename: Laerte
authors.initials: L
authors.lastname: Pastore
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: Carvalho
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*