title: Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice.
abstract: OBJECTIVE
  To describe post-extubation noninvasive positive pressure ventilation use in intensive care unit clinical practice and to identify factors associated with noninvasive positive pressure ventilation failure.
  
  
  METHODS
  This prospective cohort study included patients aged ≥ 18 years consecutively admitted to the intensive care unit who required noninvasive positive pressure ventilation within 48 hours of extubation. The primary outcome was noninvasive positive pressure ventilation failure.
  
  
  RESULTS
  We included 174 patients in the study. The overall noninvasive positive pressure ventilation use rate was 15%. Among the patients who used noninvasive positive pressure ventilation, 44% used it after extubation. The failure rate of noninvasive positive pressure ventilation was 34%. The overall mean ± SD age was 56 ± 18 years, and 55% of participants were male. Demographics; baseline pH, PaCO2 and HCO3; and type of equipment used were similar between groups. All of the noninvasive positive pressure ventilation final parameters were higher in the noninvasive positive pressure ventilation failure group [inspiratory positive airway pressure: 15.0 versus 13.7 cmH2O (p = 0.015), expiratory positive airway pressure: 10.0 versus 8.9 cmH2O (p = 0.027), and FiO2: 41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure ventilation failure group. After fitting, the logistic regression model allowed us to state that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure compared with individuals with inspiratory positive airway pressure < 13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040).
  
  
  CONCLUSIONS
  The noninvasive positive pressure ventilation failure group had a longer intensive care unit length of stay and a higher mortality rate. Logistic regression analysis identified that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure.
authors.affiliation: Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, BR.
authors.forename: Liria Yuri
authors.initials: LY
authors.lastname: Yamauchi
authors.affiliation: Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Maise
authors.initials: M
authors.lastname: Figueiroa
authors.affiliation: Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Leda Tomiko Yamada
authors.initials: LT
authors.lastname: da Silveira
authors.affiliation: Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Teresa Cristina Francischetto
authors.initials: TC
authors.lastname: Travaglia
authors.affiliation: Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Sidnei
authors.initials: S
authors.lastname: Bernardes
authors.affiliation: Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Carolina
authors.initials: C
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D017211:Treatment Failure