Non invasive

Background: A combination of early extubation and non invasive positive pressure ventilation is a good alternative for weaning from invasive ventilation in COPD patients. Objective: To evaluate the effectiveness of non invasive ventilation as a weaning method in COPD patients on mechanical ventilation in comparison to the conventional mode (synchronized intermittent mandatory ventilation with pressure support). Design: Forty patients with acute exacerbation of COPD and acute chronic respiratory failure, who were mechanically ventilated and met the criteria to proceed in a weaning attempt, but had failed a spontaneous breathing T piece trial were included in the study and randomized into two groups. Group I included twenty patients who were extubated and received non-invasive ventilation. Group II included twenty patients who were reconnected to the ventilator and continued weaning with synchronized intermittent mandatory ventilation with pressure support. Results: The duration of weaning was significantly short in group I compared to group II (35 ± 1.63 versus 47 ± 2.25 hours) (p = 0.044), duration of ICU stay was significantly shorter in group I compared to group II (9.50 ± 3.2 versus 11.4 ± 2.70 days) (p = 0.049). While the number of deaths in ICU was significantly higher (5; 25%) in group II compared to (3; 15%) group I (p = 0.031) and the number of deaths at 30 days was significantly higher (9; 45%) in group II compared to (5; 25%) group I (p = 0.008). Conclusions: Noninvasive positive pressure ventilation permits earlier removal of the endotracheal tube, reduces weaning time, stay in the intensive care unit, decreases the incidence of nosocomial pneumonia and improves 30 day survival rates.