Weaning From Noninvasive Ventilation

Inclusion criteria

Patients will be screened by the physician 24 hours (±6 hours) after initiation of NIV treatment if:

• Age ≥18 years old
• Hypercapnic ARF ( baseline pH<7.35, paCO2>45 mmHg, BORG>4)
• Breathing frequency< 25 bpm under NIV
• pH >7.35 under NIV
• 10% or more decrease from baseline PaCO2 under NIV
• Kelly ≤ 2 under NIV (Alert. Follows simple/3 step complex commands)
• PaO2 between 60 and 70 mmHg under NIV
• No need for sedation
• Systolic blood pressure 90-180 mmHg without vasopressors
• Body temperature 36-38°C
• Heart rate 50-120 bpm

The patient will be enrolled to the study and will be randomized to one of the NIV weaning protocols, if passes daily weaning criteria listed below after 1 hour of spontaneous breathing (with supplementary oxygen),

• Respiratory rate 8-30 bpm
• Systolic blood pressure 90-180 mmHg without vasopressors
• Body temperature 36-38°C
• Heart rate 50-120 bpm
• Neurologic score of Kelly ≤2 (Alert. Follows simple/ 3-step complex commands),
• SaO2 ≥88-92% with a FiO2≤40%.
• pH≥7.35
• Absence of severe dyspnea (BORG>4).

Exclusion criteria

• Age <18 years old
• NIV use at home for chronic respiratory failure
• CPAP use for acute respiratory failure
• NIV use as palliative treatment
• Severe heart failure with cardiac index ≤ 2 L/min/m2
• Severe hepatic failure with bilirubin ≥ 34.2µmol/L
• Severe renal failure with creatinine ≥ 220 µmol/L