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Objective: To determine the effectiveness of noninvasive ventilation versus conventional oxygen therapy in patients with acute respiratory failure after extubation failure. Methods: A pragmatic clinical trial was conducted in an intensive care unit from March 2009 to September 2016. Patients on mechanical ventilation > 24 hours who developed acute respiratory failure after scheduled extubation were included and were assigned to noninvasive ventilation or conventional oxygen therapy. The primary objective was to reduce the reintubation rate. The secondary objectives were to improve respiratory parameters and reduce complications, the duration of mechanical ventilation, the intensive care unit stay, the hospital stay, and mortality in the intensive care unit, in the hospital, and 90 days after discharge. Factors correlated with reintubation were also analyzed. Results: Of a total of 2,574 patients, 77 were analyzed (38 in the noninvasive ventilation group and 39 in the conventional oxygen therapy group). Noninvasive ventilation reduced the respiratory and cardiac rates more rapidly than conventional oxygen therapy. Reintubation was less common in the noninvasive ventilation group [12 (32%) versus 22 (56%) in the conventional oxygen therapy group, relative risk 0.58 (95%CI 0.34 - 0.97), p = 0.039]. The rest of the parameters did not show significant differences. In the multivariate analysis, noninvasive ventilation protected against reintubation [OR 0.17 (95%CI 0.05 - 0.56), p = 0.004], while liver failure before extubation and the inability to maintain airway patency predisposed patients to reintubation. Conclusion: The use of noninvasive ventilation in patients who failed extubation could be beneficial compared to conventional oxygen therapy. [ABSTRACT FROM AUTHOR]

Background: Complications of pancreatitis can lead to admission to the intensive care unit (ICU) with invasive mechanical ventilation. Reducing the duration of mechanical ventilation is challenging for critical care practitioners. Respiratory muscle weakness hinders the weaning process, thereby increasing the duration of mechanical ventilation and hindering pulmonary rehabilitation. Methods: We evaluated the effect of transcutaneous neuromodulation on predictors of extubation failure. The patient was a 51-year-old male with a history of type 2 diabetes, obesity (body mass index=35), and regular alcohol consumption of 40 g/day. The patient was admitted to ICU with a diagnosis of severe acute pancreatitis and multi-organ failure. Maximum inspiratory pressure (MIP), airway occlusion pressure at 100 ms (P0.1), rapid shallow breathing index (RSBI), and diaphragmatic thickening fraction (DTf) were measured. Results: The results demonstrated an improvement in all the parameters. Show an increase in MIP from -18 cmH2O to -37 cmH2O and a reduction in P0.1 from -5.7 cmH2O to -3.1 cmH2O. RSBI decreased from 107 to 72, and DTf increased from 20% to 35%. The patient was extubated successfully and discharged to the ward after a 28-day ICU stay. Conclusions: The application of transcutaneous neuromodulation led to an improvement in the predictive parameters of extubation failure in patients with severe acute pancreatitis, which was ultimately confirmed by ventilatory support not being required after extubation. Transcutaneous neuromodulation application helps improve respiratory parameters and systemic improvement of the patient until he is released from ICU. Transcutaneous neuromodulation should be used in combination with other physiotherapy techniques and should be included in a comprehensive rehabilitation protocol rather than as an isolated therapy. [ABSTRACT FROM AUTHOR]