Lung India

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 37  |  Issue : 1  |  Page : 3--7

A comparison of three strategies for withdrawal of noninvasive ventilation in chronic obstructive pulmonary disease with acute respiratory failure: Randomized trial


Kavitha Venkatnarayan1, Gopi C Khilnani2, Vijay Hadda2, Karan Madan2, Anant Mohan2, Ravindra M Pandey3, Randeep Guleria2 
1 Department of Pulmonary Medicine, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
2 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Vijay Hadda
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi
India

Background: The optimal strategy for the withdrawal of noninvasive ventilation (NIV) remains unknown. This study was planned to compare three different strategies for the withdrawal of NIV among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnic respiratory failure (HcRF). Materials and Methods: Patients with AECOPD with HcRF who improved on NIV were randomized into three groups – immediate withdrawal (Group A), stepwise reduction of pressure support (Group B), and stepwise reduction of duration (Group C) of NIV. The probability of successful withdrawal was compared among the groups. Results: This study included 90 patients (males – 86.6%) with a mean (±standard deviation [SD]) age of 59.9 ± 8.3 years. The mean (±SD) pH and PaCO2 at admission were 7.23 ± 0.04 and 84.4 ± 12.0 mm Hg, respectively. The duration of NIV received before randomization was 31.6 ± 9.2 h with maximum inspiratory positive airway pressure and expiratory positive airway pressure of 17.6 ± 2.7 cm H2O and 7.4 ± 1.4 cm H2O, respectively. NIV was successfully withdrawn in 23/30 (76.6%) in Group A, 27/30 (90%) in Group B, and 26/30 (86.6%) in Group C (P = 0.31). The total duration of NIV use and length of hospital stay was lower in Group A and B as compared to Group C (P = 0.001). Conclusions: Immediate withdrawal of the NIV after recovery of respiratory failure among patients with exacerbation of COPD is feasible. Immediate withdrawal did not increase the risk of weaning failure from the NIV.


How to cite this article:
Venkatnarayan K, Khilnani GC, Hadda V, Madan K, Mohan A, Pandey RM, Guleria R. A comparison of three strategies for withdrawal of noninvasive ventilation in chronic obstructive pulmonary disease with acute respiratory failure: Randomized trial.Lung India 2020;37:3-7


How to cite this URL:
Venkatnarayan K, Khilnani GC, Hadda V, Madan K, Mohan A, Pandey RM, Guleria R. A comparison of three strategies for withdrawal of noninvasive ventilation in chronic obstructive pulmonary disease with acute respiratory failure: Randomized trial. Lung India [serial online] 2020 [cited 2020 Jan 19 ];37:3-7
Available from: http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=1;spage=3;epage=7;aulast=Venkatnarayan;type=0