Acute Hypoxemic Respiratory Failure Clinical Trial
Official title:
Noninvasive Positive Pressure Ventilation for Early Extubation of Acute Hypoxemic Respiratory Failure
Acute hypoxaemic respiratory failure (AHRF) refers to pathological states in which arterial
blood oxygenation is severely impaired,and which need invasive positive pressure ventilation
(IPPV) as respiratory support technique in most cases.However,IPPV carries well-known risks
of complications such as ventilator induced lung injury (VILI) or ventilator associated
pneumonia (VAP),and the incidence of which is increased as the prolongation of IPPV so as to
lead to higher mortality rate. Consequently,early extubation is extraordinarily necessary.
More recently, NPPV has shown to shorten the duration of IPPV,reduce the mortality and
morbidity rates in patients with chronic obstructive pulmonary disease (COPD). Despite this
evidence, the efficacy of NPPV in patients with AHRF has not been evidenced. However,NPPV has
been shown to provide adequate ventilation and oxygenation,and reduce inspiratory muscle
effort,neuromuscular drive,and dyspnea scores. Moreover,to some patints,NPPV is similar with
IPPV in providing oxygenation.
The duration of weaning is from the first day a patient met standard criteria for weaning
readiness to the time of successful extubation (lasting at least 48 h),which represents
40-50% of the total duration of IPPV.As a result,duration of IPPV would be shortened if that
of weaning was shortened.
The investigators hypothesized that in mechanical ventilated patients with AHRF who met
standard criteria for weaning readiness and suffer failure of spontaneous breathing trial,
use of NPPV for early extubation, providing adequate ventilation and oxygenation, would
shorten the duration of IPPV as the primary end-point variable, thereby reduce the incidence
of complication and mortality rates. Accordingly, the investigators conducted a
prospective,randomized clinical trial to assess the efficacy of this strategy compared with
the conventional-weaning approach.
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