Non Invasive and Invasive Ventilation Post Extubation
Condition: Respiratory Failure With Hypoxia
MeSH terms: Respiratory Insufficiency; Hypoxia
Study type: Observational [Patient Registry]

Summary: 
      Patients and methods: It is a prospective double blind study done on total 300 patients.
      Admitted with respiratory failure ARDS due to severe lung contusion. All of them selected to
      be ventilated for one week or more. Patients were randomly allocated in one of three groups
      each group contain 100 patients. Group A considered control extubated and follow our routine
      protocol, patients of group B reconnected to mechanical ventilation before extubation for one
      hour. patients of Group C extubated and immediately connected to NIV with BIPAP mode for 1
      hour every 12 hours for 24 hours. Results: There was significant reduction in the number of
      patients had deterioration in conscious level in all the duration of the study in patients of
      both groups B and C compared to group A. Also significant reduction in the number of patients
      had deterioration in clinical parameters of respiration in all the duration of the study in
      patients of both groups B and C compared to group A as regards high respiratory rate,
      desaturation and development of hyperdynamic circulation (tachycardia and hypertension).
      significant reduction in the number of patients had multiple quadrant parenchymatous
      infiltration in all the duration of the study in patients of both groups B and C compared to
      group A. significant reduction in the number of patients had marked limitation to FEV1, FVC
      and MVV in all the duration of the study in patients of both groups B and C compared to group
      A. Conclusion: Use of either NIV every 12 hours for 24 hours or MV for one hour after
      fulfillment of weaning criteria reduces reintubation and post-extubation respiratory failure
      and decrease the ICU stay in critically ill patients with resolving ARDS due to severe lung
      trauma.
    

Detailed description: 
      It is a prospective double-blind study done on total 300 patients. Admitted to King Abdulaziz
      specialist hospital in Taif, KSA. Between April 2019 and April 2020 with respiratory failure
      ARDS due to severe lung contusion with these criteria: hypoxic index less than 200, bilateral
      parenchymatous lung infiltrate, no any acute cardiac insult, failed to maintain SPO2 more
      than 90% with Non-Invasive Ventilation (NIV) or need of continuous NIV to maintain the
      previous saturation. This selected ARDS was due to lung contusion which diagnosed by
      Computerized tomography of the chest following chest trauma. All of them selected to be
      ventilated for one week or more and only those who showed full criteria of weaning from the
      ventilator enrolled in our study. Our criteria of weaning include fully conscious patients,
      hemodynamically stable without any inotropic support, hypoxic index(PAO2/FIO2) more than 200
      calculated from the arterial blood gases (ABG), bicarbonate level in arterial blood more than
      20 mmol/l, hemoglobin level more than 10 gm%, chest X ray less than one quadrant
      parenchymatous infiltration in each lung on Murray score of chest Xray, rapid shallow
      breathing index <105. Patients were randomly allocated in one of three groups each group
      contain 100 patients. Randomization sequence was created using Excel 2007 (Microsoft,
      Redmond, WA, USA) with a 1:1 allocation using random block sizes of 2 and 4 by an independent
      doctor. In this way, sequence generation and type of randomization can be expressed at the
      same time. Patients of group A extubated and followed our routine protocol of management post
      extubation which include Nebulization with Ventolin and epinephrine racemic every 8 hours for
      48 hours, chest physical therapy (CPT) every 6 hours for 48 hours include clapping percussion
      with mechanical vibration and suction plus huffing or coughing and postural drainage if there
      was atelectasis seen by our routine chest X ray. Patients of group B reconnected to
      mechanical ventilation before extubation for one hour with sedation with midazolam 3-5
      milligram/hour intravenous infusion to achieve score 0 or -1on Richmond Agitation - Sedation
      Scale (RASS). 20 minutes before the end of this hour midazolam infusion discontinued and
      patients awaked. Patient put on mechanical ventilation (MV) with the following parameters,
      FIO2 40%, pressure SIMV mode, PEEP 8 cmH2O, Pressure support 15 cmH2O, Respiratory rate
      14/min, Peak inspiratory pressure (PIP) of 35 cmH2O. Then patients extubated and followed our
      previous protocol without the use of NIV.
    

Intervention name(s): Midazolam; ventilator
Intervention type(s): Drug; Device
Intervention description(s): reconnected to mechanical ventilation before extubation for one hour with sedation with midazolam 3-5 milligram/hour intravenous infusion to achieve score 0 or -1on Richmond Agitation - Sedation Scale (RASS). 20 minutes before the end of this hour midazolam infusion discontinued and patients awaked. Patient put on mechanical ventilation (MV) with the following parameters, FIO2 40%, pressure SIMV mode, PEEP 8 cmH2O, Pressure support 15 cmH2O, Respiratory rate 14/min, Peak inspiratory pressure (PIP) of 35 cmH2O. Then patients extubated and followed our previous protocol without the use; reconnected to mechanical ventilation before extubation for one hour with sedation
Other intervention name(s): dormicum
Intervention MeSH terms: Midazolam
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        on total 300 patients. Admitted to King Abdulaziz specialist hospital in Taif, KSA. Between
        April 2019 and April 2020 with respiratory failure ARDS due to severe lung contusion with
        these criteria: hypoxic index less than 200, bilateral parenchymatous lung infiltrate, no
        any acute cardiac insult, failed to maintain SPO2 more than 90% with Non-Invasive
        Ventilation (NIV) or need of continuous NIV to maintain the previous saturation. This
        selected ARDS was due to lung contusion which diagnosed by Computerized tomography of the
        chest following chest trauma. All of them selected to be ventilated for one week or more
        and only those who showed full criteria of weaning from the ventilator enrolled in our
        study
      
Keywords: non invasive ventilation invasive ventilation ARDS