Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

About one in six patients who are extubated after intubation for respiratory failure require reintubation. In this multicenter study, patients (about 10 percent of whom had chronic obstructive pulmonary disease) who met predefined criteria for recurrent respiratory failure within 48 hours after extubation were randomly assigned to receive medical therapy (followed by reintubation, if needed) or noninvasive ventilation by face mask (also followed by reintubation, if needed). There was no difference in the rate of reintubation between the groups. The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the standard-therapy group. Noninvasive mask ventilation is not a viable alternative to reintubation. The process of discontinuing mechanical ventilation must balance the risk of complications due to unnecessary delays in extubation with the risk of complications due to premature discontinuation and the need for reintubation. 1 , 2 Evidence-based guidelines recommend a trial of spontaneous breathing to determine, in any given patient, whether mechanical ventilation can be successfully discontinued 3 ; with this approach, the documented need for reintubation ranges from 13 to 19 percent. 4 – 7 Patients who require reintubation have been noted to have a significantly higher mortality rate than those who are successfully extubated on the first attempt. 8 , 9 The reasons for their increased . . .