chapter  10
10 Pages

Non-invasive ventilation and post-extubation respiratory failure

Physiologic bases for the use of NIV in the post-extubation period 124

Prevention of re-intubation 124

Prevention of post-extubation failure 127

References 130

Mechanical ventilation using an artificial airway is probably the most frequent life-saving procedure used in the management of critically ill patients with severe respiratory failure. Withdrawal of mechanical ventilation consists of all measures aimed at achieving successful disconnection of patients from the ventilator. Despite that, post-extubation respiratory failure may occur after discontinuation from mechanical ventilation, reintubation being needed in about 10 per cent of patients1 with a range between 4 per cent and 24 per cent. The prognosis of these patients is very poor and hospital mortality can exceed 30-40 per cent as shown in Figure 10.1.2-9 Re-intubation is associated, notably, with prolonged duration of mechanical ventilation and ICU stay – a major risk factor for nosocomial pneumonia.10