Based on clinical data, which of the following therapeutic interventions would be most beneficial for COPD patients who develop respiratory failure after extubation?

Question

A. NPPV
B. spontaneous breathing trial
C. O2 therapy with a non-rebreather mask
D. reintubation and invasive positive-pressure ventilation

Answer 1

ANS: A (page 369)
Cognitive Level: Application
A. Correct response: Patients who develop respiratory failure after extubation according to standard criteria are at high risk for morbidity and have mortality rates up to 40%. NPPV has been suggested as a treatment to avoid reintubation and to improve outcomes. Studies comparing NPPV and standard O2 therapy found no reduction in reintubation attributable to NPPV. One study even found a significantly increased ICU mortality in the NPPV group. However, studies seem to indicate that for patients who have either COPD or congestive heart failure, NPPV reduces the need for postextubation reintubation respiratory failure. Forty percent to 50% of patients in these trials had COPD or CHF, and in one study most of the benefit was attributable to the COPD subgroup. Early indiscriminate use of NPPV in patients who have risk factors for extubation failure, but do not meet standard criteria for NPPV initiation is discouraged.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.