Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Chest Diseases and Tuberculosis

Rationale: Respiratory failure after extubation and reintubation is associated with increased ICU stay, morbidity and mortality. Objectives: To assess whether early application of non invasive ventilation, immediately after extubation, is effective in decreasing length of postextubation intensive care unit stay in patients with respiratory failure type II. Methods: A prospective randomized controlled trial was conducted in 56 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode. Patients were randomly allocated after extubation to receive noninvasive ventilation for 24 h (n = 26), or standard medical treatment with oxygen therapy (control group, n = 26). Measurements and Main Results: Outcome variables in this study were, Trial duration was significantly shorter in NIV group than SMT group, and ICU stay was shorter in NIV group than SMT group but did not reach the level of significance. Respiratory failure and reintubation were less frequent in NIV group than SMT group but did not reach the level of significance (3 NIV versus 8 SMT, P =0.205). The time from extubation to respiratory failure and reintubation was longer in NIV group than SMT group and did not affect the mortality which was more frequent in SMT group than NIV group but did not reach the level of significance so this supports the use of NIV early after extubation in all patients regardless of risk for respiratory failure. Conclusions: it was concluded that early use of non-invasive ventilation after extubation decreased ICU stay, diminished risk of respiratory failure after extubation and reduced mortality in patients with respiratory failure type II

Issued also as CD