The role of noninvasive ventilation in avoiding reintubation of weaned patients from mechanical ventilation guided by expiratory and inspiratory muscle strength assessment

Abstract

Introduction Prolonged unnecessary mechanical ventilation (MV) has a multitude of complications. The main goal after placing a critically ill patient on MV is to define the best time to begin the weaning process. The peak expiratory flow (PEF) and maximum inspiratory pressure (MIP) are measures of inspiratory and expiratory muscle efficiency and can be used as weaning predictors. Noninvasive ventilation (NIV) can be used as a tool to prevent reintubation after weaning of MV. Objective The aim of this study was to determine whether prophylactic NIV would benefit patients with various cough strengths and various level of MIP to decrease the incidence of reintubation. Patients and methods In this prospective observational study, 80 mechanically ventilated patients were enrolled. At the time of their first spontaneous breathing trial, PEF and MIP were measured. Then, patients were randomly assigned to facemask and NIV groups. Results A total of 36 (90%) patients in NIV group were successfully weaned from MV, whereas four (10%) patients failed to be weaned. On the contrary, 29 (72.5%) patients in face mask group were successfully weaned from MV, whereas 11 (27.5%) patients failed to be weaned. Conclusion NIV has an important role to prevent reintubation after weaning of MV. Moreover, MIP and PEF have an excellent accuracy in prediction of NIV success after extubation.

Keywords

• maximum inspiratory pressure
• mechanical ventilation
• noninvasive ventilation
• peak expiratory flow
• weaning