Abstract
In recent years, there has been increasing interest in the use of noninvasive ventilation (NIV) in the post-extubation period to shorten the length of invasive ventilation, to prevent extubation failure, and to rescue a failed extubation. The purpose of this review is to summarize the evidence related to the use of NIV in these settings. NIV can be used to allow earlier extubation in selected patients who do not successfully complete a spontaneous breathing trial (SBT). Its use in this setting should be restricted to patients who are intubated during an exacerbation of COPD or patients with neuromuscular disease. This category of patients should be good candidates for NIV and should be extubated directly to NIV. In patients who successfully complete an SBT, but are at risk for extubation failure, NIV can be used to prevent extubation failure. These patients should also be good candidates for NIV and should be extubated directly to NIV. NIV should be used cautiously in patients who successfully complete an SBT, but develop respiratory failure within 48 hours post-extubation. In this setting, NIV is indicated only in patients with hypercapnic respiratory failure. Reintubation should not be delayed if NIV is not immediately successful in reversing the post-extubation respiratory failure. Evidence does not support routine use of NIV post-extubation.
Footnotes
- Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care, Ellison 401, Massachusetts General Hospital, Boston MA 02114, dhess{at}partners.org
Dr Hess presented a version of this paper at the New Horizons Symposium, “The Ventilator Liberation Process: A Fresh Look at the Evidence,” at the AARC Congress 2011, held November 5–8, 2011, in Tampa, Florida.
Dr Hess has disclosed relationships with Philips Respironics, ResMed, Breathe Technologies, and Pari.
Editor in Chief Dean Hess was blinded to the peer review of this paper, which was managed by Deputy Editor Richard Branson.
- Copyright © 2012 by Daedalus Enterprises Inc.