Impact of noninvasive ventilation on the outcome of extubated chronic hypercapnic patients in the respiratory intensive care Unit

• Published in: The Egyptian journal of chest diseases and tuberculosis 2018-07, Vol.67 (3), p.242-249
• Main Authors: ElNaggar, Taher, Ali, Tamer, AbdelFattah, Eman, El-Hamid, Mahmoud
• Format: Article
• Language: English
• Subjects: chronic hypercapnic respiratory failure; extubation; noninvasive ventilation; respiratory intensive care unit
• ISSN: 0422-7638; 2090-9950
• DOI: 10.4103/ejcdt.ejcdt_36_17

Background Patients with respiratory failure frequently require endotracheal intubation and mechanical ventilation to sustain life, but it has been associated with the development of many complications, making the reduction of invasive mechanical support an important goal of critical care medicine. Noninvasive ventilation (NIV) can be used to facilitate weaning (earlier extubation) and to prevent reintubation in patients with respiratory failure after planned extubation. Aim This work aimed to study the impact of NIV on the outcome of the extubated chronic hypercapnic patients and to compare it versus conventional oxygen therapy in the Respiratory Intensive Care Unit at Ain Shams University Specialized Hospital during the period spanning from October 2013 to May 2015. Patients and methods This was a prospective study that was conducted upon 80 patients divided into two groups: group A included 40 patients (29 male patients and 11 female patients with a mean age of 57.25±6.54) who were kept on NIV immediately after removal of the endotracheal tube, and group B included 40 patients (27 male patients and 13 female patients with a mean age of 59.15±5.82) who were kept on conventional oxygen therapy after removal of the endotracheal tube. Results The present study showed that 75% of patients in group A were discharged from the Respiratory Intensive Care Unit versus 42.5% of patients in group B. Moreover, it showed that only 22.5% of patients in group A required reintubation versus 52.5% of patients in group B. As regards the length of ICU stay after extubation, the present study showed that it was shorter in group A patients with a mean duration of 1.6±0.49 than that in group B patients with a mean duration of 6.13±1.79. Conclusion NIV, applied immediately after removal of the endotracheal tube, has improved the final outcome, decreased the rate of reintubation, and decreased the length of ICU stay after extubation in chronic hypercapnic respiratory failure patients.