Role of NIV in weaning from Mechanical Ventilation
Abstract
Objective: To summarise the evidence for the use of non-invasive ventilation (NIV) to allow early
extubation from mechanical ventilation and to prevent and treat respiratory distress following
cessation of invasive mechanical ventilation.
Design: Systematic review and meta analysis of randomised controlled trials (RCT).
Setting: Adult intensive care units.
Study selection criteria: Search of PubMed, Embase, ClinicalTrials.gov, intensive care medicine
conference proceedings and journals for RCTs comparing NIV with conventional weaning from
mechanical ventilation and RCTs comparing NIV with oxygen therapy for post extubation respiratory
distress.
Results: 15 RCTs were identified. Early extubation to NIV was associated with a relative risk of
death of 0.395 (95% CIs 0.183 to 0.856, p = 0.019) and a relative risk of ventilator associated
pneumonia (VAP) of 0.36 (95% CIs 0.221 to 0.588, p < 0.001) compared with conventional weaning
from mechanical ventilation. When NIV was used to treat respiratory distress following extubation,
the relative risk of death was 1.351 (95% CIs 0.771 to 2.350, p = 0.287) in the NIV group and the
relative risk of reintubation 1.026 (95% CIs 0.842 to 1.249, p = 0.802). NIV used to prevent
respiratory distress following extubation was associated with a relative risk of death of 0.657 (95%
CIs 0.415 to 1.038, p = 0.072) and relative risk of reintubation of 0.489 (95% CIs 0.294 to 0.813, p =
0.006) when compared with standard oxygen therapy.
Conclusions: Early extubation to NIV reduces mortality and VAP when compared with conventional
weaning from mechanical ventilation. NIV is a reasonable choice of technique to prevent respiratory
failure in at risk patients after the cessation of mechanical ventilation, but not for the treatment of
post extubation respiratory distress.
Iain Crossingham
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Role of NIV in weaning from Mechanical Ventilation
Early extubation to NIV compared with continued mechanical ventilation
NIV or standard oxygen therapy for established respiratory distress after extubation
NIV or standard oxygen therapy to prevent respiratory distress after extubation
Iain Crossingham
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