Noninvasive ventilation to shorten the duration of mechanical ventilation.

Noninvasive ventilation (NIV) successfully treats primary respiratory failure in chronic obstructive pulmonary disease (COPD), acute pulmonary edema, and, in some patients, hypoxemic respiratory failure. Increasingly clinicians have applied NIV in an effort to shorten the duration of mechanical ventilation by facilitating weaning and preventing or treating post-extubation respiratory failure. Randomized controlled trials (RCTs) indicate that NIV may be an effective weaning tool in a subset of patients with acute-on-chronic respiratory failure from COPD, and that applying immediate NIV to extubated patients at high risk for extubation failure improves outcome by decreasing the need for reintubation. In contrast, there is mixed evidence about the effectiveness of NIV to treat established post-extubation respiratory failure. NIV appeared to be ineffective in heterogeneous patient populations in some randomized trials that enrolled relatively few patients with COPD, and a case-control study found that NIV decreased the need for reintubation in this group. Therefore, as with primary therapy, NIV should be considered for patients with COPD and post-extubation respiratory distress.