Should a Patient Be Extubated and Placed on Noninvasive Ventilation After Failing a Spontaneous Breathing Trial?
Authors: Epstein, Scott K; Durbin, Charles G
Source: Respiratory Care, Volume 55, Number 2, February 2010 , pp. 198-208(11)
Publisher: The Journal Respiratory Care Company
Abstract:Between 15% and 35% of mechanically ventilated patients fail an initial spontaneous breathing trial. For these patients, 40% of total time on mechanical ventilation is consumed by the weaning process (60% for patients with chronic obstructive pulmonary disease). Longer duration of mechanical ventilation is associated with higher risk of complications and probably with higher mortality. Noninvasive ventilation (NIV) has been used successfully in some forms of acute respiratory failure. Randomized controlled trials have indicated that, in selected patients with chronic obstructive pulmonary disease and acute-on-chronic respiratory failure, NIV can facilitate weaning, reduce the duration of invasive mechanical ventilation, decrease complications, and reduce mortality, compared to weaning on continued invasive ventilation. However, extubation failure resulting in re-intubation is associated with higher mortality, and this mortality risk increases with delay of re-intubation and may not be prevented by application of NIV. Patients extubated to NIV must have careful monitoring by skilled clinicians able to provide timely re-intubation if the patient shows signs of intolerance or worsening respiratory failure.
Document Type: Research Article
Publication date: 2010-02-01
- As of January 1, 2013, Respiratory Care content will no longer be hosted on ingentaconnect. Please contact the publisher at email@example.com for information on how to continue access to this title.
- Editorial Board
- Information for Authors
- Submit a Paper
- Subscribe to this Title
- Membership Information
- Information for Advertisers
- Clinical Practice Guidelines
- Past OPEN FORUM Abstracts
- ingentaconnect is not responsible for the content or availability of external websites