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Noninvasive ventilation therapy reduces reintubation risk

Patients who received noninvasive ventilation therapy after hypoxemic respiratory failure following abdominal surgery had a reduced risk of reintubation 7 days after initiation of ventilator therapy, according to recent research.

“Among patients with hypoxemic respiratory failure following abdominal surgery, use of noninvasive ventilation compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days,” Samir Jaber, MD, PhD, from the Département d’Anesthésie Réanimation B (DAR B), in Montpellier, France, and colleagues wrote in their study. “These findings support use of [noninvasive ventilation] in this setting.”

Jaber and colleagues evaluated 293 patients (mean age 63.4 years) between May 2013 and September 2014 who underwent abdominal surgery in an intensive care unit and went on to develop hypoxemic respiratory failure within 7 days of surgery, according to the abstract. Hypoxemic respiratory failure was defined as a partial oxygen pressure < 60 mm Hg, an oxygen saturation of ≤ 90% when breathing room air or < 80 mm Hg when breathing 15 L/min of oxygen. Patients received either standard oxygen therapy to maintain oxygen saturation levels of 94% or higher (145 patients) or noninvasive ventilation.

They found that 49 of 148 (33.1%) patients in the noninvasive ventilation group experienced reintubation within 7 days compared with 66 of 145 (45.5%) patients in the standard oxygen therapy group (absolute difference = −12.4%; 95% CI, −23.5% to −1.3%; P = 0.03), according to the abstract. Patients in the noninvasive ventilation group also experienced more ventilator-free days (25.4 days) compared with the standard care (23.2 days) group (absolute difference = −2.2 days; 95% CI, −0.1 to 4.6 days; P = 0.04) as well as fewer health care-associated infections (31.4%) compared with the standard care (49.2%) group (absolute difference = −17.8%; 95% CI, −30.2% to −5.4%; P = 0.003).

Regarding follow-up, there were no significant differences in gas exchange; however, Jaber and colleagues noted 14.9% of patients in the noninvasive ventilation group and 21.5% of patients in the standard care group at 90 days, according to the abstract. – by Jeff Craven

Disclosure: Jaber is a paid consultant for Drager, Maquet, Hamilton, and Fisher & Paykel Healthcare. The other authors report various financial disclosures. Please see the full study for a complete list of disclosures.