Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Introduction: With emerging evidence supporting other interventions, there is a need to re-examine the safety and efficacy of postextubation noninvasive ventilation (NIV) support in high-risk patients. Methods: Data were collected over 4-year period from a multispeciality ICU. High-risk criteria were uniform, and the application of NIV was protocolized. Successful extubation was defined as the absence of both reintubation and NIV support at 72 hours postextubation. Results: Extubation success was achieved in 79.6%. At extubation, more patients in the failure group had chronic neurological or kidney diseases, longer days of invasive ventilation, higher sequential organ failure assessment score, and more positive fluid balance. Significant differences were also observed In the Indications for prophylactic NIV between the two groups. However, in logistic regression analysis, none of these differences observed in univariate analysis was independently associated with extubation outcome. Failure of postextubation NIV was associated with higher hospital mortality (67.7 vs 10.7%, p <0.001) and longer ICU/hospital length of stay (median 10 vs 6 days, p <0.001 and 13 vs 10 days, p <0.01, respectively). No differences were observed in extubation outcomes between 2016 to 2017 and 2018 to 2019 cohorts. Conclusion: High rate of extubation failure and worse patient-centric outcomes associated with prophylactic NIV calls for a relook into the current recommendation of NIV for this indication.