BARCELONA—Repeated failure to wean a patient from invasive mechanical ventilation is associated with an increased risk of complications, including death. A randomized trial demonstrates that in patients who have difficulty weaning, noninvasive ventilation (NIV) can shorten the length of time on mechanical ventilation and thereby reduce the incidence of nosocomial pneumonia, increase survival, and shorten hospital and ICU stays.[1]

NIV has been shown to be helpful in weaning patients who have suffered exacerbations of chronic obstructive pulmonary disease, and it can also reduce duration of invasive mechanical ventilation in patients with acute respiratory failure. Thus, Miguel Ferrer, MD, and colleagues at the Institut Clinic de Pneumologia i Cirurgia Toracica in Barcelona sought to test NIV’s value in reducing the need for mechanical ventilation in patients for whom repeated weaning trials have failed.

Forty-three mechanically ventilated patients who had experienced weaning failure on three successive days were randomized to either NIV or continued invasive mechanical ventilation. The 21 patients given NIV were extubated and then ventilated using a face mask; after a minimum of 24 hours of administration, NIV was gradually withdrawn until the patients could sustain spontaneous breathing. The other 22 patients remained on invasive ventilation and continued with the daily weaning attempts.

The study was halted midway after an interim analysis found that the duration of invasive ventilation was 11 days shorter in the NIV patients. Furthermore, the total period of ventilatory support was reduced by nine days in the NIV group.

In addition, the probability of weaning success was significantly higher in the patients receiving NIV. Only one (5%) of these patients required tracheotomy, as compared with 13 (59%) of the other patients. NIV also shortened ICU and hospital stays by 11 and 13 days, respectively. Although the reintubation rate was lower in the NIV patients (14% vs 27%), the difference did not reach significance.

Nosocomial pneumonia developed in only five (24%) of the patients receiving NIV, as compared with 13 (59%) of the patients who continued on invasive ventilation; likewise, septic shock occurred in two (9.5%) of NIV recipients but in nine (41%) of the other patients. Nineteen (90%) of the NIV patients survived their stay in the ICU, whereas only 13 (59%) of the other patients did so.

—Mimi Zucker, PhD

Reference
1. Ferrer M, Esquinas A, Arancibia F, et al. Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med. 2003;168:70-76.

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