PURPOSE: The aim of the study was to assess the usefulness of non invasive ventilation as an early extubation and weaning technique in acute on chronic respiratory failure(ACRF) secondary to acute exacerbation of COPD(AECOPD).
METHODS: Among 384 consecutively intubated patients admitted for ACRF due to AECOPD, a prospective, randomized controlled trial of weaning was conducted in 264 patients who failed a 2-h spontaneous breathing trial, although they met simple criteria for weaning. Conventional invasive pressure support ventilation (IPSV) was used as the control weaning technique in 130 patients (IPSV group), and NIV was applied immediately after extubation in 134 patients (NIV group).
RESULTS: No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 100 of 130 patients were successfully weaned and extubated, versus 124 of 134 in the NIV group (p <0.001 ). NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during a 2-h spontaneous breathing trial (p < 0.05). The duration of ETI was significantly shorter in the NIV (4.52± 0.87 d) than in the IPSV group (7.06 ± 1.32 d) (p < 0.001). NIV reduced significantly the duration of ETI, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.
CONCLUSIONS: 1- NIV like IPSV significantly and similarly improves gas exchange during weaning, of patients with ACRF secondary to AECOPD, from invasive MV.2-NIV reduces significantly the duration of ETI, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.
CLINICAL IMPLICATIONS: NIV should be considered as an early extubation and weaning technique in patients with AECOPD associated with ACRF
DISCLOSURE: The following authors have nothing to disclose: Gamal Agmy, Mohamed Metwally
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