Editor's Pick: Intensive Care Medicine journal
Rosanna Vaschetto, Emilia Turucz, Fabrizio Dellapiazza, Stefania Guido, Davide Colombo, Gianmaria Cammarota, Francesco Della Corte, Massimo Antonelli, Paolo Navalesi
Original - Volume 38, Issue 10 / October 2012
Since a systematic evaluation of NIV that anticipates extubation in patients with non hypercapnic hypoxemic ARF was lacking and several concerns have been raised, we conducted a small randomised controlled pilot study that aimed to assess this application of NIV. NIV was applied after extubation in 10 patients and compared with conventional weaning with the endotracheal tube in place in 10 other patients (controls). In the intervention group, no patient interrupted the study protocol; in addition, arterial blood gases were no worse than in the control group. Although the study was not powered for any outcome variable, 28-day-invasive-ventilation-free-days were higher in the intervention group, compared to the control group. This study indicates that early extubation followed by immediate NIV application in hypoxemic ARF is feasible, at least by a team with extensive NIV experience in very selected patients; a properly powered trial may ascertain whether this approach provides benefit to these patients.
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