Noninvasive proportional assist ventilation may be useful in weaning patients who failed spontaneous breathing trial

Background: Endotracheal mechanical ventilation (ETMV) is accompanied with a high morbidity and mortality in intensive care unit (ICU) patients. The aim of this prospective randomized controlled study was to evaluate the effectiveness of noninvasive proportional assist ventilation (PAV) as a method of weaning in patients who could not tolerate spontaneous breathing trial (SBT). Patients and methods: Among 112 patients presented with acute respiratory failure (ARF) admitted to Zagazig university surgical ICU, 42 patients of them failed a 2 h-SBT after they met simple criteria for weaning. Conventional invasive synchronized intermittent mandatory ventilation (SIMV) was used as the control weaning technique in 21 patients (SIMV group), and noninvasive PAV was applied immediately after extubation in the remaining 21 patients (PAV group). Results: There was no significant difference regarding the main clinical, functional characteristics, and the physiologic parameters of the two weaning groups at the time of their admission. Gas exchange at 1-h post-randomisation was significantly improved in both groups. The duration of ventilatory support was significantly shorter in the PAV group (12.8 + 8.3 days vs 22.3 + 13.3 days in the conventional group; P < 0.05). Weaning success was significantly higher in the PAV group (18 patients 85%'' vs 11 patients 52 %'' in the conventional group P < 0.05). ICU survival was higher, while, reintubation rate was lower in PAV (three patients 14%'' vs 10 patients 47%'' in the conventional group; P < 0.05). The rate of tracheostomy was significantly lower in the PAV group (one patient 4%'' vs seven patients 33%'' in the conventional group; P < 0.05). The incidence of VAP was higher in the conventional group (eight patients 38%'' vs one patient 4%'' in the PAV group; P < 0.05). Conclusion: Noninvasive PAV could be considered as an effective and safe method of weaning in patients who cannot tolerate 2 h-SBT. (C) 2011 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V.