Does Noninvasive Ventilation Prevent Reintubation in Patients with Obesity?

Noninvasive ventilation (NIV) prevents reintubation in patients at risk for postextubation failure with hypercapnia, but the evidence is variable in patients without elevated blood carbon dioxide levels. Patients with obesity (body-mass index, >30 kg/m²) might be particularly responsive to NIV beyond its effect on ventilation, likely because NIV promotes easier breathing and improves atelectasis.

To examine whether NIV can prevent reintubation in obese patients at intermediate risk for postextubation failure and without hypercapnia (see Table), investigators randomized 142 patients who had been mechanically ventilated for >24 hours to either high-flow nasal cannula (HFNC) or NIV for 48 hours. Crossover was not allowed. The reintubation rate …