Related Experiment Video
Updated: Jul 10, 2026

A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Role of noninvasive positive-pressure ventilation in postextubation respiratory failure: a meta-analysis
Ritesh Agarwal1, Ashutosh N Aggarwal, Dheeraj Gupta
1Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. riteshpgi@gmail.com
Background:
There is a need for an intervention that prevents re-intubation in patients who have been weaned off mechanical ventilation. Noninvasive positive-pressure ventilation (NPPV) has been shown to facilitate weaning in mechanically ventilated patients.
Objectives:
To assess the effect of NPPV on re-intubation rate and intensive care unit and/or hospital mortality in patients with postextubation respiratory failure.
Methods:
We searched the MEDLINE, EMBASE, OVID, CINAHL, DARE, and CENTRAL databases for relevant studies published from 1980 to 2006, and included randomized controlled trials that evaluated the role of NPPV in patients with postextubation respiratory failure. Independently and in duplicate, two of us abstracted data from these trials. Differences in opinion were settled via consensus or after consultation with a third author.
Results:
Four studies met our inclusion criteria: two used NPPV in the setting of established postextubation respiratory failure, and two used NPPV in patients "at risk" for postextubation respiratory failure. NPPV, compared to the standard medical therapy, did not decrease the re-intubation rate (relative risk [RR] 1.03, 95% confidence interval [CI]0.84-1.25) or intensive care unit mortality (RR 1.14, 95% CI 0.43-3.0) in patients (n = 302) with postextubation respiratory failure. However, in patients (n = 259) who were defined to be at high risk for developing postextubation respiratory failure, NPPV decreased the re-intubation rate (RR 0.46, 95% CI 0.25-0.84) and intensive care unit mortality (RR 0.26, 95% CI 0.1-0.66), but not the hospital mortality (RR 0.71, 95% CI 0.42-1.20).
Conclusions:
Current evidence suggests that NPPV should be used judiciously, if at all, in patients with postextubation respiratory failure, but it appears to be promising as a prophylaxis to prevent re-intubation in patients "at risk" for developing postextubation respiratory failure.
Related Concept Videos
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
Mechanical Ventilation I: Indication and Settings