Impact on outcome of non invasive ventilation after extubation

The use of non-invasive ventilation (NIV) after extubation may improve patient’s conditions. The aim of our study was to analyze the impact of the use of NIV after extubation on outcome. Methods: This was a monocentric, observational, descriptive, and retrospective study carried out during 2018 at the intensive care unit. Patients who received NIV after extubation, were included. The impact on outcome was analyzed based on the risk of intubation and the death. Results: During the study period, 194 patients were intubated, of which 46 received post-extubation NIV. The average age was 61±15 years. NIV was preventive in 27 patients (59%), systematic in 15 (32%) and therapeutic in 4 (9%). The reintubation rate was 28% in a mean delay of 3±2 days. The mean length of stay in intensive care was 17±15 days and the mean length of stay in hospital was 20±17 days. Mortality rate was 24%. Reintubation was associated in univariate analysis with a prolonged duration of weaning (p =0.023), a need of systematic NIV (p=0.054) and the use of higher levels of pressure support (p=0.005). In multivariate analysis, systematic NIV (p=0.048) and high levels of pressure support (p=0.023) were independent risk factors of reintubation. Mortality was associated in the univariate analysis with: admission for metabolic disorder (p=0.012), pneumonia or tracheobronchitis associated to ventilation: p=0.006 and p=0.025. In multivariate analysis, reintubation was the only independent risk factor of mortality. Post-extubation NIV did not impact mortality. Conclusions: Ventilator weaning with early extubation to NIV was associated with a significant risk of reintubation. However, this practice was not an independent risk factor for post-extubation mortality.