The role of non-invasive positive pressure ventilation in the weaning and peri-extubation period

Partial support for patients with respiratory failure can be provided with invasive mechanical ventilation or non-invasive mechanical ventilation. The role of non-invasive positive pressure ventilation (NPPV) in preventing intubation for various conditions has been well studied. Less well studied is the role for NPPV in the weaning and peri-extubation period.

by Dr Brooks A. Fallis  and Dr Karen E. A. Burns

Mechanical ventilation is essential for supporting patients through episodes of respiratory failure by unloading respiratory muscles and improving gas exchange. While potentially lifesaving, invasive mechanical ventilation with an endotracheal tube or tracheostomy can be associated with important harm, in part due to complications such as ventilator associated pneumonia (VAP). VAP has been shown to increase morbidity and trends towards increasing mortality [1].

Critical care physicians strive to extubate patients as early as possible, while minimising the risk of re-intubation, which has been shown to be independently associated with increased risk of developing VAP [2]. Spontaneous breathing trials (SBT) are used to decide if a patient has been weaned.  An SBT involves a focused assessment of a patient