Báo cáo y học: Noninvasive mechanical ventilation during the weaning process: facilitative, curative, or preventive

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Noninvasive mechanical ventilation during the weaning process: facilitative, curative, or preventive?
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Báo cáo y học: "Noninvasive mechanical ventilation during the weaning process: facilitative, curative, or preventive" Available online http://ccforum.com/content/12/2/136CommentaryNoninvasive mechanical ventilation during the weaning process:facilitative, curative, or preventive?Massimo Antonelli and Giuseppe BelloPoliclinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, ItalyCorresponding author: Massimo Antonelli, m.antonelli@rm.unicatt.itPublished: 21 April 2008 Critical Care 2008, 12:136 (doi:10.1186/cc6853)This article is online at http://ccforum.com/content/12/2/136© 2008 BioMed Central LtdSee related research by Trevisan et al., http://ccforum.com/content/12/2/R51Abstract randomization, and the mortality were not statistically different when comparing the groups. Furthermore, the percentage ofTo avoid the complications associated with endotracheal intuba- complications in the NPPV group was lower (28.6% versustion, noninvasive positive-pressure ventilation (NPPV) has been 75.7%), with a lower incidence of pneumonia (3.6% versusproposed in the management of ventilator weaning in patients withacute respiratory failure (ARF) of various etiologies. Several studies 45.9%) and tracheotomy (0% versus 18.9%), than in thehave been performed to assess the benefit of NPPV in various invasive ventilation group. These results led the authors toweaning strategies, including permitting early extubation in patients conclude that early extubation and NPPV is a valid alternativewho fail to meet standard extubation criteria (facilitation use), for ventilation in a group of heterogeneous patients thatavoiding reintubation in patients who fail extubation (curative use), initially failed weaning.and preventing extubation failure in nonselected and selectedpatients (preventive use). NPPV has been successfully used infacilitating early extubation, particularly in patients with chronic NPPV is increasingly being proposed in the management ofobstructive pulmonary disease. In contrast, applying curative NPPV the ventilator weaning process, to avoid the complications ofto treat postextubation ARF in nonselected populations may not be endotracheal intubation [2], and thereby to potentially lowereffective and could even be deleterious. Early use of NPPV was morbidity and mortality rates in selected patients with ARFsuccessful in preventing ARF after extubation, and decreased the [3,4].need for reintubation in selected patients at risk of developingpostextubation ARF. It is important that caregivers clearly differen-tiate among these application modalities of NPPV. The skills and The first report to assess the role of NPPV as a weaningexpertise of both medical and nonmedical personnel are crucial technique dates back to 1992, when NPPV was successfullypredictive factors for the success of NPPV in the ventilator used in assisting the return of spontaneous breathing in aweaning process. small group of 22 patients with chronic respiratory insufficiency and weaning difficulties [5]. Several trials haveIn the present issue of Critical Care, the use of noninvasive been performed thereafter to further determine the benefit ofpositive-pressure ventilation (NPPV) as a facilitative weaning NPPV in permitting early extubation in patients who fail totechnique has been clinically assessed by Trevisan and meet standard extubation criteria [6-9] (facilitation technique),colleagues [1]. Sixty-five patients on invasive mechanical in avoiding reintubation in patients who fail extubation [10-13]ventilation for >4 ...