Ventilation noninvasive post-extubation : quelles indications pour quels patients ?

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• 作者：A. W. Thille (1) (2)
  A. Demoule (3) (4) (5)
  
  1. CHU de Poitiers ; r茅animation m茅dicale ; CHU de Poitiers ; 2 rue la Mil茅trie ; F-86021 ; Poitiers Cedex ; France
  2. INSERM CIC 1402 ; Universit茅 de Poitiers ; Poitiers ; France
  3. UMR_S 1158 芦 neurophysiologie respiratoire exp茅rimentale et clinique 禄 ; Sorbonne Universit茅s ; UPMC Univ Paris 06 ; F-75005 ; Paris ; France
  4. UMR_S 1158 芦 Neurophysiologie Respiratoire Exp茅rimentale et Clinique 禄 ; INSERM ; F-75005 ; Paris ; France
  5. service de pneumologie et r茅animation m茅dicale (d茅partement R3S) ; AP-HP ; groupe hospitalier Piti茅-Salp锚tri猫re Charles Foix ; F-75013 ; Paris ; France
  
• 关键词：Ventilation noninvasive ; Sevrage ; Extubation ; Insuffisance respiratoire aigu毛 ; Broncho ; pneumopathie chronique obstructive ; R茅animation ; Non ; invasive ventilation ; Ventilator weaning ; Extubation ; Acute respiratory failure ; Chronic obstructive pulmonary disease ; Intensive care unit
• 刊名：Réanimation
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：24
• 期：1
• 页码：11-19
• 全文大小：172 KB
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• 刊物主题：Emergency Medicine; Anesthesiology; Intensive / Critical Care Medicine;
• 出版者：Springer Paris
• ISSN：1951-6959

文摘

Non-invasive ventilation (NIV) is widely used for the treatment of acute respiratory failure in the intensive care unit and has been therefore naturally used to hasten extubation and avoid reintubation. In the post-extubation period, three different situations should be clearly distinguished: 1) The first situation is the use of NIV to hasten extubation in difficult-to-wean patients. Despite the failure of a weaning trial, the patient is extubated and treated by intensive NIV after extubation. This strategy can be discussed for some patients with chronic respiratory failure but cannot be routinely proposed as reference method in clinical practice. 2) The second situation is the use of prophylactic NIV immediately applied after planned extubation, i.e. before the occurrence of a respiratory distress in patients ready for extubation. This strategy should be systematically used in order to prevent post-extubation acute respiratory failure in hypercapnic patients with any underlying chronic lung disease. Further studies are needed to expand its use in other patients considered at high risk for extubation failure. 3) The third situation is the use of therapeutic NIV to treat patients who have already signs of respiratory distress. This strategy can be dangerous and should not be used in clinical practice, except in postoperative patients after thoracic surgery or in patients with chronic lung disease. Clinical trials on weaning are difficult because of the low number of reintubated patients. However, despite the absence of current recommendations, the literature enables to justify some propositions.