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Critical Care

, 3:P027 | Cite as

Noninvasive mechanical ventilation (NIMV) in weaning failure: could be an alternative approach?

  • A Esquinas
  • D González
  • A Carrillo
  • M Del Baño
  • M Rodríguez
  • F García
  • P Jara
Meeting abstract

Keywords

Hemodynamic Instability Facial Mask Respiratory Insufficiency Muscular Activity Pressure Support Ventilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

A trial with noninvasive ventilation (NIMV) could be a safe alternative option in some selected unweanneable patient, after a period of invasive approach of weaning with: 1) Endotracheal tube (ET) or 2) Traqueostomizated with a `T' oxygen or Pressure support Ventilation (PSV) trials.

Setting

Polyvalent ICU.

Subjects

We show a cases series where NIMV have been applied as an alternative weaning technique in three difference clinical situations of unweanneability: 1) Post-extubation failure n = 12, 2) Decanulation in traqueostomizated n = 1, and 3) Elective extubation n = 3.

Material

NIMV with BiPAP ST-D (Resp, Inc) ventilator, facial mask.

Methods

Inclusion criteria: acute respiratory insufficiency in a period (0–48 h): respiratory rate >30 rpm, increase accessory respiratory muscular activity, hypoxemia PaO2 < 60 mmHg at mask venturi (FIO2: 0.5) after a period of `T' piece or PSV and almost four consecutive weaning failure trials. Excluded: hemodynamic instability (SAT < 90 mmHg), uncooperative patients, and excessive secretions., IPAP/EPAP cmH2O to achieve: >10 ml/Kr and decrease in dysnea Borg score. Continuous cardiorespiratory monitoring.

Results

Unweanneable population n = 16. Average age: 61 ± 20, male n = 12; APACHE II score: 21 ± 3, time of NIMV: 72 ± 12 h.

NIMV was effective in reduce dysnea Borg scores (4 to 2), gasometric alterations and avoid reintubation 8/12. Causes of exclusion: secretions 23%, hemodynamic instability 15%. Complications: skin lesion n = 2, gastric distension n = 1.

Conclusion

1). A trial with a NMV as a weaning alternative technique is a safe alternative in selected patients with showed a persistent weaning failure. 2). Reduction in ICU stay, mortality, with a great comfort and few complications compare to others method.

Table

Weaning

 

Success

Failure

Exclusion

Postextubation - NMV

n = 12

8

3

1

Decanulation - NIMV

n = 1

0

1

 

Extubation - NIMV

n = 3

1

1

1

UCI stay

 

4 ± 2

15 ± 5

 

Mortality

 

2%

15%

 

Results

n = 16

9

5

2

Copyright information

© Current Science Ltd 1999

Authors and Affiliations

  • A Esquinas
    • 1
  • D González
    • 1
  • A Carrillo
    • 1
  • M Del Baño
    • 1
  • M Rodríguez
    • 1
  • F García
    • 1
  • P Jara
    • 1
  1. 1.Intensive Care UnitHospital Morales MeseguerMurciaSpain

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