Protocols for Weaning From NIV: Appraisal of Evidence

Abstract

Before attempting weaning one has to assess whether the patient is ready for wean or not. A patient who has recovered from the underlying condition and has acceptable clinical and physiological parameters (weaning criteria) he / she, is ready for weaning from NIV. The clinical and physiological parameters used in this setting include-arterial pH ≥ 7.35, oxygen haemoglobin saturation (SpO 2) > 90% on FiO 2 ≤ 50%, respiratory rate ≤ 25 / min, heart rate ≤ 120 / min, systolic blood pressure ≥ 90 mmHg and no signs of respiratory distress like agitation, diaphoresis or anxiety. Patient satisfying these criteria, there can be three ways by which weaning from NIV may be done-stepwise reduction of duration of NIV use, stepwise reduction in pressure support and immediate withdrawal of NIV. Stepwise reduction of NIV use This strategy involves gradually increasing the NIV free interval over few days (usually 2-3 days) and then complete removal of NIV.