Document Detail


Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning.
MedLine Citation:
PMID:  10382235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Extubation failure is significantly associated with increased morbidity and mortality in mechanically ventilated patients. In respiratory distress after extubation, non-invasive positive pressure ventilation (NIPPV) has been suggested to avoid the complications of invasive mechanical ventilation. The purpose of this study was to evaluate the effect of early application of NIPPV on extubation outcome. We conducted a prospective study in 93 extubated patients with a mean age of 72.7 +/- 14.7 years (range, 24-93). Elective extubation was performed in 56 patients and unplanned extubation occurred in 37 patients. After extubation, patients randomly received either biphasic positive airway pressure (BIPAP) therapy (n = 47) or unassisted oxygen therapy (n = 46). Non-invasive positive pressure ventilation was delivered via face mask in BIPAP group. Of the 93 extubated patients, 73 (78.5%) were successfully extubated, and 20 (21.5%) had to be re-intubated. There were no significant differences in age, sex, pre-extubation blood gas data between re-intubated patients and those who were not re-intubated. While seven of the 46 patients in the unassisted oxygen therapy group required re-intubation, 13 of the 47 BIPAP-treated patients also required re-intubation. This difference was not statistically significant. The postextubation respiratory management, BIPAP or unassisted oxygen therapy, did not correlate with the extubation outcome, but the elective extubation had significantly better outcome than unplanned extubation. Patients with excessive bronchial secretions and intolerance to the equipment are poor candidates for NIPPV. We conclude that early application of BIPAP support did not predict a favourable extubation outcome. Our experience did not support the indiscriminate use of NIPPV to facilitate ventilator weaning.
Authors:
J S Jiang; S J Kao; S N Wang
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  4     ISSN:  1323-7799     ISO Abbreviation:  Respirology     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-07-29     Completed Date:  1999-07-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  161-5     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC. marconi@m2.is.net.tw
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Blood Gas Analysis
Female
Humans
Intermittent Positive-Pressure Ventilation / instrumentation,  methods*
Laryngeal Masks
Male
Middle Aged
Oxygen Inhalation Therapy / methods
Precipitating Factors
Prospective Studies
Respiratory Insufficiency / etiology,  metabolism,  physiopathology,  therapy*
Time Factors
Treatment Outcome
Ventilator Weaning / adverse effects,  methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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