TEMPLATE DESIGN © Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to COPD. A RCT Stefano, N., Ambrosino, N., & Clini, E. etc. (1998). Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized controlled trial. American College of Physicians, 128(9), Abstract DiscussionArticle 1 and Evidence Article 2 and Evidence Conclusion Results Clinical Significance Summary Lightowler, J. V., Wedzicha, J. A., & Elliot, M. W. (2002). Non-invasive positive pressure venitlation to treat respiratory failure from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. British Medical Journal, Retrieved from NIV positive pressure has less complication with treatment and shorter length of stay An outcome this systematic review did not determine was if the NIV decreased developing nosocomial pneumonia like the original article. Systematic literature review that reviewed only RCTs. Articles reviewed by two using Cochrane database Specific inclusion and exclusion criteria Purpose Background/Intro Weaning failure rate is often high in patients with COPD Prolonged mechanical ventilation can potentially increase complications Methods and Materials Acute relapse of COPD randomly assigned from three hospitals Random assignment performed using opaque envelopes. 50 patients were divided according to assignment, survival and successful and unsuccessful weaning Criteria for accessing weaning:: SaO2 of 90% or more, FiO2 of 40% or less, pH of 7.35 or more, respiratory rate less than 35 breaths/min, hemodynamic stability, absence of severe dyspnea, and depressed neurologic state 25 patients were extubated and 25 were intubated Day 60, 88% NIV weaned successfully, 68% successful weaned invasively Time in ICU was shorter in patients with noninvasive technique No NIV developed pneumonia, 7 invasively developed pneumonia 92% survival with noninvasive technique 72% with invasive NIV technique can shorten stay in ICU, decrease incidence of pneumonia, and increase survival Study was conducted on a certain group of severely hypercapnic patients with COPD NIV technique is more time consuming and costly Success of NIV technique is likely due to avoiding complicated artificial airways Excluded if known prior medical condition Different types of ventilation techniques to treat acute COPD patients NIV technique shows greater results in weaning patients off the ventilator Physical therapists need to be aware to monitor patients arterial blood gases, blood pressure, and signs of pneumonia. Patients with acute COPD can have NIV intubation which can decrease weaning time, duration in ICU, likelihood of pneumonia and higher survival rate Physicians and PT’s need to be aware that people who have IMV may respond differently to exercise compared to NIV Results were statistically significant. NIV had more benefits, but used on acute COPD NIV benefits: improved endurance, decreased LOS, pneumonia, mortality, pH, improved RR and arterial gases DESIGN: Multicenter, randomized trial. SETTING: Three respiratory intensive care units. PATIENTS: Intubated patients with chronic obstructive pulmonary disease and acute hypercapnic respiratory failure. INTERVENTION: A T-piece weaning trial was attempted 48 hours after intubation. If this failed, two methods of weaning were compared: 1) extubation and application of noninvasive pressure support ventilation by face mask and 2) invasive pressure support ventilation by an endotracheal tube. MEASUREMENTS: Arterial blood gases, duration of mechanical ventilation, time in the intensive care unit, occurrence of nosocomial pneumonia, and survival at 60 days. RESULTS: At admission, all patients had severe hypercapnic respiratory failure (mean pH, 7.18+/-0.06; mean PaCO2, 94.2+/ mm Hg), sensory impairment, and similar clinical characteristics. At 60 days, 22 of 25 patients (88%) who were ventilated noninvasively were successfully weaned compared with 17 of 25 patients (68%) who were ventilated invasively. The mean duration of mechanical ventilation was 16.6+/-11.8 days for the invasive ventilation group and 10.2+/-6.8 days for the noninvasive ventilation group (P = 0.021). Among patients who received noninvasive ventilation, the probability of survival and weaning during ventilation was higher (P = 0.002) and time in the intensive care unit was shorter (15.1+/-5.4 days compared with 24.0+/-13.7 days for patients who received invasive ventilation; P = 0.005). Survival rates at 60 days differed (92% for patients who received noninvasive ventilation and 72% for patients who received invasive ventilation; P = 0.009). None of the patients weaned noninvasively developed nosocomial pneumonia, whereas 7 patients weaned invasively did. CONCLUSIONS: Noninvasive pressure support ventilation during weaning reduces weaning time, shortens the time in the intensive care unit, decreases the incidence of nosocomial pneumonia, and improves 60-day survival rates. To determine whether noninvasive ventilation (NIV) improves the outcome of weaning from invasive mechanical ventilation (IMV) Schonhofer, B., Wallstein, S., Wiese, C., & Kohler, D. (2001). Noninvasive mechanical ventilation improves endurance performance in patients with chronic respiratory failure due to thoracic restriction. American College of Chest Physicians, 119, NIV mechanical ventilation improved gas exchanges in COPD Results similar to original article despite it speaking more of endurance performance Prospective case control study, level 4 on evidence Experimental design with manipulations of variables and data collection prospective Presentation by: Kayla Klope, PT student Bellarmine Univeristy