Non-invasive ventilation after extubation

The effectiveness of non-invasive ventilation (NIV) in the management of difficult or prolonged weaning has most convincingly been shown for hypercapnic respiratory failure, mainly due to COPD. In this context three different clinical scenarios should be distinguished. First NIV as a systematic technique to facilitate early extubation leading to a decrease in ventilator-associated pneumonia and mortality, second, NIV as a preventive strategy immediately after planned extubation in patients showing risk factors for recurrent respiratory failure, and third, NIV application as a rescue therapy in patients with apparent respiratory failure after planned extubation, revealing the potential to avoid re-intubation in hypercapnic patients with pre-existing respiratory disorders. In non-COPD patients with hypoxemic respiratory failure after extubation, NIV cannot generally be recommended. NIV application within the weaning process requires a high degree of experience in this technique and progress to urgent re-intubation must not be delayed. © 2010 Springer Medizin Verlag.