Protocols for Weaning From NIV: Appraisal of Evidence

Abstract

Before attempting weaning one has to assess whether the patient is ready for wean or not. A patient who has recovered from the underlying condition and has acceptable clinical and physiological parameters (weaning criteria) he / she, is ready for weaning from NIV. The clinical and physiological parameters used in this setting include -arterial pH ≥ 7.35, oxygen haemoglobin saturation (SpO 2 ) > 90% on FiO 2 ≤ 50%, respiratory rate ≤ 25 / min, heart rate ≤ 120 / min, systolic blood pressure ≥ 90 mmHg and no signs of respiratory distress like agitation, diaphoresis or anxiety. Patient satisfying these criteria, there can be three ways by which weaning from NIV may be done -stepwise reduction of duration of NIV use, stepwise reduction in pressure support and immediate withdrawal of NIV.

Neurally-Adjusted Ventilatory Assist Versus Noninvasive Pressure Support Ventilation in COPD Exacerbation: The NAVA-NICE Trial

“…Pressure support was reduced gradually by 2-4 cm H 2 O every 4 -6 h until pressure support Յ 4 -6 cm H 2 O was attained, after which NIV was withdrawn. 18 The weaning protocol for NAVA was similar to one described previously by Garzando and colleagues. 19 Weaning from NAVA-NIV was considered when, at the same NAVA level, there was a decline in peak EA di signal with minimal change in tidal volume and reduction in peak airway pressures.…”