Noninvasive Positive-Pressure Ventilation for Postextubation Respiratory Distress: A Randomized Controlled Trial
2002
ContextNoninvasive positive-pressure ventilation (NPPV) has been demonstrated
to be effective in preventing the need for endotracheal intubation in some
patients who present with acute respiratory failure. It is also used for patients
who develop acute respiratory distress after extubation, but there are no
randomized controlled trials that address its effectiveness in this population.ObjectiveTo determine the effectiveness of NPPV compared with standard medical
therapy in preventing the need for endotracheal reintubation in high-risk
patients who develop respiratory distress during the first 48 hours after
extubation.DesignRandomized, controlled, unblinded study with concealed allocation conducted
between August 1, 1996 and October 31, 1999.SettingAn intensive care unit (ICU) in an academic, tertiary care hospital
in Ontario.PatientsEighty-one patients with a history of cardiac or respiratory disease
or who initially required ventilatory support for more than 2 days and who
developed respiratory distress within 48 hours of extubation.InterventionsPatients were randomly assigned to receive standard medical therapy
alone (supplemental oxygen to maintain oxygen saturation by pulse oximetry ≥95%;
n = 42) or NPPV by face mask plus standard medical therapy (n = 39).Main Outcome MeasuresRates of reintubation, duration of mechanical ventilation, lengths of
ICU and hospital stay, and hospital mortality.ResultsComparing the NPPV group with the standard-therapy group, there was
no difference in the rate of reintubation (72% vs 69%; relative risk, 1.04;
95% confidence interval, 0.78-1.38) or hospital mortality (31% for both groups;
relative risk, 0.99; 95% confidence interval, 0.52-1.91). Similarly, no difference
was found in duration of mechanical ventilation or length of ICU or hospital
stay.ConclusionsThe addition of NPPV to standard medical therapy does not improve outcome
in heterogeneous groups of patients who develop respiratory distress during
the first 48 hours after extubation.
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