• Christophe Girault, Michael Bubenheim, Fekri Abroug, Jean Luc Diehl, Souheil Elatrous, Pascal Beuret, Jack Richecoeur, Erwan L'Her, Gilles Hilbert, Gilles Capellier, Antoine Rabbat, Mohamed Besbes, Claude Guérin, Philippe Guiot, Jacques Bénichou, Guy Bonmarchand, and VENISE Trial Group.
• Department of Medical Intensive Care, Rouen University Hospital, Rouen, France. Christophe.Girault@chu-rouen.fr
• Am. J. Respir. Crit. Care Med.. 2011 Sep 15;184(6):672-9.

RationaleThe use of noninvasive ventilation (NIV) as an early weaning/extubation technique from mechanical ventilation remains controversial.ObjectivesTo investigate NIV effectiveness as an early weaning/extubation technique in difficult-to-wean patients with chronic hypercapnic respiratory failure (CHRF).MethodsIn 13 intensive care units, 208 patients with CHRF intubated for acute respiratory failure (ARF) who failed a first spontaneous breathing trial were randomly assigned to three groups: conventional invasive weaning group (n = 69), extubation followed by standard oxygen therapy (n = 70), or NIV (n = 69). NIV was permitted as rescue therapy for both non-NIV groups if postextubation ARF occurred. Primary endpoint was reintubation within 7 days after extubation. Secondary endpoints were: occurrence of postextubation ARF or death within 7 days after extubation, use of rescue postextubation NIV, weaning time, and patient outcomes.Measurements And Main ResultsReintubation rates were 30, 37, and 32% for invasive weaning, oxygen-therapy, and NIV groups, respectively (P = 0.654). Weaning failure rates, including postextubation ARF, were 54, 71, and 33%, respectively (P < 0.001). Rescue NIV success rates for invasive and oxygen-therapy groups were 45 and 58%, respectively (P = 0.386). By design, intubation duration was 1.5 days longer for the invasive group than in the two others. Apart from a longer weaning time in NIV than in invasive group (2.5 vs. 1.5 d; P = 0.033), no significant outcome difference was observed between groups.ConclusionsNo difference was found in the reintubation rate between the three weaning strategies. NIV decreases the intubation duration and may improve the weaning results in difficult-to-wean patients with CHRF by reducing the risk of postextubation ARF. The benefit of rescue NIV in these patients deserves confirmation.

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