Related Experiment Video
Updated: May 13, 2026

A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
A pilot randomized study comparing two methods of non-invasive ventilation withdrawal after acute respiratory failure
Chung-Tat Lun1, Veronica L Chan, Wah-Shing Leung
1Division of Respiratory Medicine, Department of Medicine, United Christian Hospital, Hong Kong SAR, China.
Background And Objective:
Patients with chronic obstructive pulmonary disease (COPD) presenting with acute hypercapnic respiratory failure (AHcRF) benefit from non-invasive ventilation (NIV). The best way to withdraw NIV is not known, and we conducted a pilot study comparing stepwise versus immediate withdrawal of NIV in these patients.
Methods:
This was a prospective, single-centre, open-labelled randomized study comparing stepwise versus immediate withdrawal of NIV in patients with COPD exacerbation recovering from AHcRF. The primary end-point was the success rate of NIV withdrawal, defined as no restarting of NIV from randomization to 48 h after complete withdrawal of NIV.
Results:
Sixty patients were randomized, 35 patients to stepwise withdrawal and 25 patients to immediate withdrawal. The two study arms were clinically comparable. There was no statistically significant difference in the success rate, with NIV successfully stopped in 74.3% and 56% in the stepwise and immediate withdrawal groups, respectively (P = 0.139).
Conclusions:
We could not show any benefits for either strategy to withdraw NIV. The study may have been underpowered to detect differences, and larger prospective studies are required.
Related Concept Videos
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
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...
Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
Mechanical Ventilation I: Indication and Settings
