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Noninvasive versus invasive ventilation in weaning of patients with type 2 respiratory failure

Objective The aim of this study was to investigate noninvasive ventilation (NIV) effectiveness as an early weaning technique in difficult-weaning patients with chronic hypercapnic respiratory failure. Background Although invasive ventilation is effective, it is associated with complications like ventilator-associated pneumonia. Ventilator-associated pneumonia has been associated with increased morbidity and mortality. So, minimizing the duration of invasive mechanical support without increasing the risk of adverse events is an important goal. NIV may provide a means of reducing the duration of invasive mechanical support for patients with respiratory failure. Patients and methods A prospective, randomized controlled study was conducted on 40 mechanically ventilated patients having chronic obstructive pulmonary disease with acute exacerbation and type 2 respiratory failures. As the patients were considered for weaning, those who failed the spontaneous breathing trial were randomly allocated into two groups each of 20 patients as follows: (1) Group 1: patients were extubated and received NIV. (2) Group 2: patients received invasive ventilation and were gradually weaned. Results There was no statistically significant difference between the two groups in invasive ventilation-free days at day 28 (P = 0.885), mechanical ventilation period (P = 0.688), weaning duration in hours (P = 0.578), ICU stay (P = 0.427), and 28-day survival rate (P = 0.518). Although there were a higher number of complications in group 1 compared with group 2, the difference was statistically insignificant. Conclusion NIV has no upper hand in weaning of difficult-weaning patients with chronic hypercapnic respiratory failure over invasive ventilation.