title: Noninvasive ventilation during the weaning process in chronically critically ill patients.
abstract: Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01-1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97). NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Dept, Hospital Clínico Universitario, Valencia, Spain; INCLIVA Institute of Health Research, Valencia, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Sancho
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Dept, Hospital Clínico Universitario, Valencia, Spain; INCLIVA Institute of Health Research, Valencia, Spain; Dept of Physical Therapy, Universitat de Valencia, Valencia, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.affiliation: Unidad Médico-Quirurgica de Enfermedades Respiratorias, Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Luis
authors.identifier: 0000-0002-4125-3376
authors.initials: L
authors.lastname: Jara-Palomares
authors.affiliation: Unidad Médico-Quirurgica de Enfermedades Respiratorias, Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Barrot
authors.affiliation: Unidad Médico-Quirurgica de Enfermedades Respiratorias, Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Sanchez-Oro-Gómez
authors.affiliation: Servicio de Neumología, Hospital San Pedro Alcántara, Cáceres, Spain; Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Gómez de Terreros
authors.affiliation: Servicio de Neumología, Hospital San Pedro Alcántara, Cáceres, Spain; Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain.
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Martín-Vicente
authors.affiliation: Servicio de Neumología, Hospital San Pedro Alcántara, Cáceres, Spain; Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Utrabo
authors.affiliation: Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: M Belen
authors.initials: MB
authors.lastname: Núñez
authors.affiliation: Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Binimelis
authors.affiliation: Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Sala
authors.affiliation: Intermediate Care Unit, Pulmonology Dept, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Zamora
authors.affiliation: Intermediate Care Unit, Pulmonology Dept, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Segrelles
authors.affiliation: Servicio de Neumología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Ortega-Gonzalez
authors.affiliation: Servicio de Neumología, Hospital San Pedro Alcántara, Cáceres, Spain; Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES), University Carlos III, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Masa