RESUMO
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