Non-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial

Non-invasive positive pressure ventilation (NPPV) is a well established therapy for acute respiratory failure in patients with chronic obstructive pulmonary disease, however its role in post-extubation period is uncertain. The objective of this study was to find the effect of NPPV on rate of re-intubation, intensive care unit and hospital stay, and physiological parameters in severe chronic obstructive pulmonary disease patients after planned extubation. Forty patients with severe chronic obstructive pulmonary disease were randomised immediately after planned extubation to receive NPPV (n=20) or conventional therapy (n=20). NPPV was delivered with mean levels of inspiratory positive-airway pressure of 12.10 +/- 1.37 cmH(2)O and expiratory positive-airway pressure of 6.50 +/- 1.00 cmH(2)O for a mean period of 34.75 +/- 10 hours for 7 to 11 hours/day. Patients in conventional therapy group received usual treatment. Reintubation rate among NPPV (15%) and conventional (25%) were similar (P=0.44). The duration of intensive care unit stay after extubation (2.05 +/- 2.15 vs 1.55 +/- 0.82 days, P=0.34) and hospital stay (16.10 +/- 6.29 vs 18.25 +/- 7.91 days, P=0.34) in both groups were comparable. Given the load of chronic obstructive pulmonary disease patients and wide availability of NPPV it is safe to recommend its use in these patients soon after extubation, although clear benefit is not documented in this study.