Noninvasive positive-pressure ventilation: a silver bullet for extubation failure?

Extubation failure, or the need for reintubation within 24–72 hours of extubation, occurs in up to 25% of critically ill patients. Extubation failure is associated with a markedly increased morbidity and mortality, including duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, the need for post-acute-care hospitalization, and the need for tracheostomy.1,2 The most common cause of extubation failure is respiratory failure secondary to respiratory, cardiac, or neuromuscular disease. In this case, it seems plausible to consider the use of noninvasive positive-pressure ventilation (NPPV), given the extensive evidence that supports the use of NPPV to prevent intubation. The use of NPPV in the post-extubation period might be considered in 3 different clinical scenarios: (1) to allow earlier extubation, (2) to prevent extubation failure, and (3) to prevent reintubation in the setting of extubation failure.