Published in:
01-10-2012 | Editorial
Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time
Published in: Intensive Care Medicine | Issue 10/2012
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Once patients have been intubated during an episode of acute respiratory failure, physicians must work diligently to extubate them successfully as soon as possible [1]. Ignoring this fundamental tenet exposes patients to unnecessary morbidity and mortality [1‐3]. The three components of management include treatment of the cause of respiratory failure, measurement of weaning predictors, and trials of unassisted breathing [4] (Fig. 1).
Fig. 1
Schematic representation of the clinical course of patients affected by acute respiratory failure (ARF) receiving invasive mechanical ventilation. Early in the clinical course the etiology responsible for ARF is dynamic (left circle). The partial pressure of oxygen to fractional inspiratory oxygen ratio (PaO2/FiO2) is low and pulmonary mechanics are severely restricted. Most of these patients would die unless invasive mechanical ventilation is not promptly instituted. Patients who survive the initial insult can experience various degrees of recovery (large right circle). In some of these patients, weaning parameters are satisfactory, and most of them are successfully extubated. Whether noninvasive mechanical ventilation should be used in patients recovering from an episode of ARF who have satisfactory or unsatisfactory weaning parameters remains to be determined
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