title: [Noninvasive positive pressure ventilation in patients with acute respiratory failure after tracheal extubation].
abstract: OBJECTIVE
  Noninvasive positive pressure ventilation (NPPV) has been routinely used to assist the weaning of the mechanical ventilation. One of the applications most common is in patients who had acute respiratory failure after extubation, even the scientific evidences for this indication still controversy. The aims of this study were to evaluate the index of patients that evolve for respiratory failure after extubation and evaluated the effectiveness of NPPV to avoid the need for reintubation and to promote increase in success index of weaning.
  
  
  METHODS
  We conducted a transversal and prospective study. It was applied to NPPV in the patients who presented respiratory failure after extubation, independent of its etiology. NPPV was applied in to pressure support ventilation, with Vte for 6 to 8 mL/kg, PEEP and FiO2 adjusted to reach SaO2 > 95%. The NPPV was accomplished of a continuous mould even interrupt the signs of respiratory failure presented initially. The success of weaning and the NPPV was defined when the clinical events were reverted by a period greater than 48 hours in spontaneous breathing, avoid thus reintubation.
  
  
  RESULTS
  We included 103 patients. Noted that 32% (33) evolved with signals of respiratory failure after extubation and were submitted to NPPV. The time of NPPV was on mean 8 ± 5 hours, PSV of 12 ± 2 cmH2O, PEEP of 7 ± 2 cmH2O, FiO2 of 40% ± 20%, Vte of 462 ± 100 mL, RR of 26 ± 5 rpm. Among patients who accomplished NPPV (33), 76% (25) attended with success and them afterwards let the ICU. Of the patients assigned to NPPV, 24% (8) did not tolerate the procedure and were reintubated.
  
  
  CONCLUSIONS
  We conclude that NPPV is safe and effective in averting the need for reintubation in patients with respiratory failure after extubation.
authors.affiliation: Santa Casa de São Paulo.
authors.forename: Anderson
authors.initials: A
authors.lastname: José
authors.affiliation: Santa Casa de São Paulo.
authors.forename: Luiz Rogério de Carvalho
authors.initials: LR
authors.lastname: Oliveira
authors.affiliation: Santa Casa de São Paulo.
authors.forename: Elaine Cristina Polleti
authors.initials: EC
authors.lastname: Dias
authors.forename: Daniela Brandão
authors.initials: DB
authors.lastname: Fuin
authors.forename: Leslie Gomes
authors.initials: LG
authors.lastname: Leite
authors.forename: Graziele de Souza
authors.initials: Gde S
authors.lastname: Guerra
authors.forename: Deise do Carmo
authors.initials: Ddo C
authors.lastname: Barbosa
authors.affiliation: Serviço de Terapia Intensiva, Santa Casa de São Paulo, Faculdade de Ciên-cias Médicas.
authors.forename: Paulo Antonio
authors.initials: PA
authors.lastname: Chiavone