NON-INVASIVE POSITIVE PRESSURE VENTILATION VERSUS CONVENTIONAL OXYGEN THERAPY AFTER EXTUBATION IN PATIENTS WITH HYPERCAPNIC RESPIRATORY INSUFFICIENCY

Abstract

The need of reintubation after extubation and discontinuation of mechanical ventilation (MV) is not uncommon and is associated with increased morbidity and mortality. Non invasive positive pressure ventilation (NIPPV) has been suggested as promising therapy to avoid respiratory failure after extubation. The aim of this work is to study the effectiveness of NIPPV compared to conventional oxygen therapy after planned extubation on the rate of reintubation as well as weaning outcome in patients with hypercapnic respiratory insufficiency. Patients and methods: This study was carried out at Chest Department, Zagazig University Hospitals during the period from September 2011 to August 2013. The study included 100 invasively mechanically ventilated patients with hypercapnic respiratory failure (69 males and 31 females). According to the applied therapy after extubation, the patients were randomly classified into two equal groups, Group I received NIPPV and GroupII received conventional oxygen therapy after extubation.
Results: The rate of reintubation in group I (18%) was significantly lower than in group II (38%). The mortality rate in group I (8%) was significantly lower than in group II (24%). After extubation, the duration of ICU stay in group I (3.48 ± 1.4 days) was significantly shorter than in group II (4.4 ± 1.32 days) but no significant difference between the stay duration in general medical floor of both groups. The rate of occurrence of the various therapy related complications (tracheotomy, postextubation stridor, VAP, arrhythmias and heamodynamic affection) was significantly lower in group I than in group II. Gastric distention (22%) and mask related complications (20%) occurred only in group I patients.
Conclusions: The use of NIPPV immediately after extubation in patients with hypercapnic respiratory insufficiency can decrease reintubation and mortality rate, duration of ICU stay and the rate of occurrence of the various therapy related complications especially tracheostomy and VAP.
Key words: NIPPV, Conventional oxygen therapy, extubation.