The aim of this study was to assess the usefulness of non invasive ventilation as an early extubation and weaning technique in ACRF secondary to COPD.
Among 72 consecutively intubated COPD patients admitted for ACRF, a prospective, randomized controlled trial of weaning was conducted in 37 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 18 patients (IPSV group), and NIV was applied immediately after extubation in 19 patients (NIV group).
No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 12 of 18 patients were successfully weaned and extubated, versus 15of 19 in the NIV group (p <0.05). 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 (4.79± 0.87 d) than in the IPSV group (8.03 ± 1.39 d) [p < 0.001]. NIV reduced significantly the duration of ventilatory support, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.
NIV is a useful method for early weaning from invasive mechanical ventilation among COPD patients with acute on top of chronic respiratory failure.
NIV should be considered as an early extubation and weaning technique in patients with COPD and ACRF who are difficult to wean.
G.M. Rabie, None.