Role of non invasive ventilation in limiting re-intubation after planned extubation

Introduction: In critically ill adult patients, particularly patients with chronic obstructive pulmonary disease (COPD), early use of non invasive ventilation (NIV) after weaning may be associated with the decrease of mortality. The effect of this benefit is not so clear in ICU mixed populations. Aim of the work: Compare the efficacy of NIV to Oxygen Mask in preventing re-intubation if NIV was used immediately following planned extubation in patients with respiratory failure of various etiologies requiring mechanical ventilation for more than 48 h. Patients and methods: One hundred and twenty patients were randomly enrolled in this study. Sixty patients assigned to the noninvasive-ventilation group received ventilation through a full facial mask from a BIPAP ventilator located in the intensive care unit immediately after extubation (group I) while the other sixty patients put on oxygen mask group will be (group II) and act as control group. Results: There was no significant difference regarding sex distribution and smoking pattern, also APACHE II score, hemodynamic and electrolytes which might have a role in respiratory failure showed no statistically significant differences between both studied groups .The mean duration of mechanical ventilation was lower in group I than in group II, 6.2 ± 1.6 versus 7.1 ± 1.8 days, respectively, however this difference was not significant (p-0.09). The overall re-intubation rate (15%) was significantly lower in group I compared to group II which was 25% and p-value 0.04. The re-intubation rate of COPD patients in group I was statistically lower than group II (p-0.019). Hospital mortality rate showed a statistically significant difference between both groups, with four deaths during ICU stay in the NIV group (6.6%), while there were 10 deaths (16.6%) in the Oxygen Mask group (p < 0.035). Conclusion: Early application of non invasive ventilation could be effective in limiting the need for re-intubation and decrease mortality in electively extubated patients with various aetiologies of respiratory failure. Also selected patients with respiratory failure (COPD) may get more benefit from this therapy