CONTEXT: Noninvasive positive-pressure ventilation (NPPV) has been demonstrated to be effective in preventing the need for endotracheal intubation in some @entity1 who present with @entity1576 . It is also used for @entity1 who develop acute @entity649 after extubation, but there are no randomized controlled trials that address its effectiveness in this population. OBJECTIVE: To determine the effectiveness of NPPV compared with standard medical therapy in preventing the need for endotracheal reintubation in high-risk @entity1 who develop @entity649 during the first 48 hours after extubation. DESIGN: Randomized, controlled, unblinded study with concealed allocation conducted between August 1, 1996 and October 31, 1999. SETTING: An intensive care unit (ICU) in an academic, tertiary care hospital in Ontario. @entity1 : Eighty-one @entity1 with a history of @entity299 or who initially required ventilatory support for more than 2 days and who developed @entity649 within 48 hours of extubation. INTERVENTIONS: @entity1 were randomly assigned to receive standard medical therapy alone (supplemental @entity26 to maintain @entity26 saturation by pulse oximetry > or = 95%; n = 42) or NPPV by face mask plus standard medical therapy (n = 39). MAIN OUTCOME MEASURES: Rates of reintubation, duration of mechanical ventilation, lengths of ICU and hospital stay, and hospital mortality. RESULTS: Comparing the NPPV group with the standard-therapy group, there was no difference in the rate of reintubation (72% vs 69%; relative risk, 1.04; 95% confidence interval, 0.78-1.38) or hospital mortality (31% for both groups; relative risk, 0.99; 95% confidence interval, 0.52-1.91). Similarly, no difference was found in duration of mechanical ventilation or length of ICU or hospital stay. CONCLUSIONS: The addition of NPPV to standard medical therapy does not improve outcome in heterogeneous groups of @entity1 who develop @entity649 during the first 48 hours after extubation.

Noninvasive positive-pressure ventilation for postextubation XXXX : a randomized controlled trial.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'PATIENTS'] @entity649 :: ('MESH:D012128', 'Disease') :: ['respiratory distress'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity1576 :: ('MESH:D012131', 'Disease') :: ['acute respiratory failure'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac or respiratory disease']
@entity649 :: (MESH:D012128,Disease) :: ['respiratory distress']
