Successful Extubation After Weaning Failure by Noninvasive Ventilation in Patients With Neuromuscular Disease: Case Series

Abstract

ObjectiveTo report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation.MethodsPatients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO2 (ETCO2) and pulse oxyhemoglobin saturation (SpO2) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days.ResultsA total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive.ConclusionNIV may promote successful weaning in neuromuscular patients with experience of reintubation.

Weaning from mechanical ventilation in people with neuromuscular disease: protocol for a systematic review

“…NMD are characterised by progressive muscular impairment, with difficulty in ambulation, swallowing and ventilation, with progressive reduction of vital capacity and increased work of breathing 3. These changes lead to the development of chronic respiratory insufficiency, which is an important cause of prolonged ventilatory dependence 4…”

“…The majority of critically ill patients admitted to ICU require ventilatory support for acute or chronic respiratory failure,3 specially the NMD ones. In addition, the pattern of neuromuscular abnormalities associated with critical illness, defined as ICU-acquired weakness (ICUAW),4 can lead to prolonged mechanical ventilation, a longer hospital stay and increased ventilation 4…”

“…Weaning difficulty may occur in different populations, such as elderly with prolonged ICU hospitalisation, people with chronic respiratory diseases or NMD 12. Therefore, the decision to progress to extubation is more challenging in this group of people with advanced respiratory muscle weakness, and this can lead to a need for tracheostomy and prolonged mechanical ventilation 4…”

“…Successful weaning is defined as the ability to maintain spontaneous ventilation without the need for reintubation and invasive mechanical ventilation for 48 hours after extubation 10. For patients with NMD, due to the difficulty of weaning, it may be also defined as the absence of a need for tracheostomy and mechanical ventilation for 5 days after extubation 4…”

“…Postweaning monitoring should observe whether two of the following findings are present: respiratory acidosis (pH <7.35; PaCO 2 >45 mm Hg); SpO 2 <90% or PaO 2 <60 mm Hg with FiO 2 >50%; i>35 rpm; decreased level of consciousness, restlessness or excessive sweating; or signs suggestive of respiratory muscle fatigue, such as the use of accessory muscles or paradoxical movement of the abdomen, in order to determinate the need to re-establish mechanical ventilation again 4 10…”