Noninvasive positive pressure ventilation is required following extubation at the pulmonary infection control window: a prospective observational study

Introduction: Timely extubation and sequential invasive to noninvasive positive pressure ventilation (NPPV) at the pulmonary infection control (PIC) window is beneficial for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, it remains unclear whether patients can breathe independently at the PIC window and if NPPV is indeed necessary after extubation. Objectives: To assess whether AECOPD patients can breathe independently at the PIC window and thus whether NPPV is necessary after extubation. Methods: We performed a prospective observational study at a university hospital during a 9-month period. We used the spontaneous breathing trial (SBT) to assess whether each patient could breathe independently at the PIC window, then performed extubation. Patients who passed the SBT received venturi oxygen therapy only, whereas those that failed received NPPV. However, if the former showed respiratory distress, they too received NPPV. The primary outcome variables were SBT pass/fail, the demand for NPPV and rate of reintubation within 72 h following extubation. Results: In all, 23 patients were enrolled, 15 (65%) of which passed the SBT. Of these, 12 (80%) developed respiratory distress after extubation and required NPPV (one of whom required reintubation). Of the eight patients that failed, one received reintubation after NPPV. The reintubation rates within 72 h following extubation of SBT-pass (7%) and SBT-fail (13%) patients were comparable. Conclusion: Our results provide experimental evidence that most AECOPD patients can breathe independently at the PIC window, but nonetheless develop respiratory distress and thus require NPPV following extubation.