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Noninvasive ventilation in the weaning of patients with acute-on-chronic respiratory failure due to COPD [with consumer summary]
Agmy GM, Metwally MM
Egyptian Journal of Chest Diseases and Tuberculosis 2012 Jan;61(1):83-92
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Endotracheal intubation (ETI) and mechanical ventilation are often needed in patients with acute-on-chronic respiratory failure (ACRF) due to acute exacerbations of COPD. Prolonged duration of ETI is associated with an increased morbidity and mortality in intensive care unit patients. 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: A prospective, randomized trial of weaning was conducted among consecutively intubated patients admitted for ACRF due to AECOPD. Patients who failed a 2-h spontaneous breathing trial (SBT), although they met simple criteria for weaning, received either conventional invasive pressure support (IPSV) that was used as the control weaning technique (IPSV group), or NIV that was applied immediately after extubation (NIV group). RESULTS: We recruited 384 of consecutively intubated patients admitted for ACRF due to AECOPD in respiratory ICU, Assiut university Hospital, Egypt. We had 264 cases who failed the conventional SBT and were recruited to other conventional invasive pressure support ventilation (IPSV) (130 patients of IPSV group), or NIV immediately after extubation (134 patients of NIV group). No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 78 of 130 patients (60%) were successfully weaned and extubated, versus 106 of 134 (79%) 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 than in the NIV (4.79 +/- 0.87 d) than in the IPSV group (8.03 +/- 1.38 d) (p < 0.01). NIV reduced significantly the duration of ETI, weaning failure, nosocomial pneumonia, tracheostomy, ICU stay and mortality. CONCLUSIONS: NIV like IPSV significantly and similarly improves gas exchange during weaning of patients with ACRF, secondary to AECOPD, from invasive MV. Also, it reduces significantly the duration of ETI, weaning failure, nosocomial pneumonia, tracheostomy, ICU stay and mortality.

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