<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

Abstract

BackgroundProphylactic noninvasive ventilation (NIV) after scheduled extubation can benefit patients with chronic respiratory disorders, among which chronic obstructive pulmonary disease (COPD) is a significant example. However, it is not known whether all COPD patients benefit from prophylactic NIV.MethodsWe performed a post hoc analysis of prospectively collected data. COPD patients who successfully completed a spontaneous breathing trial were enrolled. In the prophylactic NIV group, NIV was applied immediately after extubation. In the usual care group, conventional oxygen therapy was used. Patients were followed up to 90 days post-extubation.ResultsAmong patients with PaCO2 > 45 mmHg, 128 and 40 received prophylactic NIV and usual care, respectively. Prophylactic NIV led to lower rates of re-intubation (4% vs 30% at 72 h and 11% vs 35% at 7 days, both p < 0.01) and hospital mortality (18% vs 40%, p < 0.01) than usual care. The proportion of 90-day mortality was also lower in the prophylactic NIV group (log rank test, p = 0.04). Among patients with PaCO2 ≤ 45 mmHg, 32 and 21 received prophylactic NIV and usual care, respectively. In this cohort however, prophylactic NIV neither reduced re-intubation (6% vs 5% at 72 h, p > 0.99, and 9% vs 14% at 7 days, p = 0.67) nor hospital mortality (19% vs 24%, p = 0.74). The proportion of 90-day mortality did not differ between the two groups (log rank test, p = 0.79).ConclusionThis exploratory study shows that prophylactic NIV benefits COPD patients with PaCO2 > 45 mmHg, but it may not benefit those with PaCO2 ≤ 45 mmHg. Further study with a larger sample size is required to confirm this.

Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

“…Sensitivity analysis also indicated that NIV remains the most effective method in nonhypercapnic critically ill medical patients. However, an observational study by Gong et al [54] found a conflicting result that prophylactic NIV could not reduce re-intubation or hospital mortality in COPD patients with PaCO 2 < 45 mmHg. It is noteworthy that in our NMA, most trials that enrolled nonhypercapnic patients had a high risk of extubation failure.…”

Post-extubation&nbsp;Oxygenation Strategies&nbsp;and Mortality and&nbsp;Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

“…COPD is a risk factor for reintubation after extubation and predisposes patients to hypercapnia during SBT [46]. Thus, NPPV is more effective than COT for patients with hypercapnia after extubation [50], which possibly led to differences in results between our study and that of Zhou et al Furthermore, including trials with many COPD patients potentially increases the patient heterogeneity. Therefore, we excluded trials where COPD patients accounted for >50% of the study population.…”

Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

“…COPD is a risk factor for reintubation after extubation and predisposes patients to hypercapnia during SBT [ 46 ]. Thus, NPPV is more effective than COT for patients with hypercapnia after extubation [ 50 ], which possibly led to differences in results between our study and that of Zhou et al Furthermore, including trials with many patients with COPD potentially increased the patient heterogeneity. Therefore, we excluded trials where COPD patients accounted for > 50% of the study population.…”