Skip to main content

Predictors of failure of early shift from invasive to noninvasive ventilation in weaning chronic obstructive pulmonary disease patients who have failed the initial spontaneous breathing trial: a prospective cohort study



Noninvasive ventilation (NIV) is a well-established modality for difficult and prolonged weaning of chronic obstructive pulmonary disease (COPD) patients. Although several studies have addressed the early shifting to NIV, predictors of its success remain to be determined.


The aim of the study was to find predictors of success of early shift of COPD patients who have failed the spontaneous breathing trail (SBT) to NIV.

Design and settings

This investigation was designed as a double-centered prospective cohort study involving the ICUs of Critical Care Medicine of Cairo University and Shebin El-Kom Teaching Hospital.

Patients and methods

Consecutive COPD patients who failed the initial SBT were extubated and shifted to NIV. We compared arterial blood gases, lung mechanics, and spontaneous breathing parameters in successful patients with these parameters in those who failed the early shift to NIV.


Out of the 30 patients, 21 (70%) were successfully weaned by early shift to NIV. The failed group had a significantly higher autopositive end-expiratory pressure (P<0.001), rapid shallow breathing index (RSBI) (P<0.05), and significantly lower static compliance and negative inspiratory pressure (NIP) (P<0.001) on admission.

Admission RSBI and NIP were the only predictors of failure of early shift to NIV. Just before SBT, the failed group had a significantly higher autopositive end-expiratory pressure (P<0.001), RSBI (P<0.001), and airway resistance (Raw) (P<0.001) and significantly lower static compliance, NIP, and PO2/FIO2 (P/F) ratio. Raw and NIP before SBT were the only predictors of success of early shift to NIV.


RSBI, NIP, and Raw, rather than arterial blood gases, are the most important predictors for success of early shift to NIV in COPD patients who have failed the initial SBT.


  1. Song Y, Chen R, Zhan Q, Chen S, Luo Z, Ou J, et al. The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection. Int J Chron Obstruct Pulmon Dis 2016; 11:535–542.

    Article  Google Scholar 

  2. Ezingeard E, Diconne E, Guyomarc’h S, Venet C, Page D, Gery P, et al. Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med 2006; 32:165–169.

    Article  Google Scholar 

  3. Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006; 130:1664–1671.

    Article  Google Scholar 

  4. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian J Crit Care Med 2008; 12:1–9.

    Article  Google Scholar 

  5. Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ 2014; 186: E112–E122.

    Article  Google Scholar 

  6. Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G. Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med 1999; 160:86–92.

    CAS  Article  Google Scholar 

  7. Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014; 174:1982–1993.

    Article  Google Scholar 

  8. Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 1998; 128:721–728.

    CAS  Article  Google Scholar 

  9. Burns KE, Adhikari NK, Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth 2006; 53: 305–315.

    Article  Google Scholar 

  10. Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, et al. Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 2003; 168: 70–76.

    Article  Google Scholar 

  11. Collaborating Research Group for Noninvasive Mechanical Ventilation of Chinese Respiratory Society. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J (Engl) 2005; 118:1589–1594.

    Google Scholar 

  12. Peng L, Ren PW, Liu XT, Zhang C, Zuo HX, Kang DY, et al. Use of noninvasive ventilation at the pulmonary infection control window for acute respiratory failure in AECOPD patients: a systematic review and meta-analysis based on GRADE approach. Medicine (Baltimore) 2016; 95: e3880.

  13. Zhang XL. Pulmonary infection control window as a switching point for consequential ventilation: an encouraging finding in treatment of acute respiratory failure of chronic obstructive pulmonary disease. Chin Med J (Engl) 2005; 118:1587–1588.

    Google Scholar 

  14. Conti V, Paone G, Mollica C, Sebastiani A, Mannocci A, La Torre G, et al. Predictors of outcome for patients with severe respiratory failure requiring non invasive mechanical ventilation. Eur Rev Med Pharmacol Sci 2015; 19: 3855–3860.

    CAS  PubMed  Google Scholar 

  15. Tokgoz Akyil F, Gunen H, Agca M, Gungor S, Yalcinsoy M, Sucu P, et al. Patient outcome after chronic obstructive pulmonary disease exacerbations requiring non-invasive ventilation during hospitalization. Arch Bronconeumol 2016; 52:470–476.

    Article  Google Scholar 

  16. Pacilli AM, Valentini I, Carbonara P, Marchetti A, Nava S. Determinants of noninvasive ventilation outcomes during an episode of acute hypercapnic respiratory failure in chronic obstructive pulmonary disease: the effects of comorbidities and causes of respiratory failure. Biomed Res Int 2014; 2014:976783.

    Article  Google Scholar 

  17. Salim S, Fahmy T, Yehia A, Abed N, Mokhtar S. Predictors of success for early transition from invasive to non invasive mechanical ventilation in weaning copp patients after acute respiratory failure; a prospective cohort trial. Intensive Care Med 2013; 39:S358-S358. Abstract.

    Google Scholar 

  18. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29:1033–1056.

    Article  Google Scholar 

  19. Vitacca M, Ambrosino N, Clini E, Porta R, Rampulla C, Lanini B, et al. Physiological response to pressure support ventilation delivered before and after extubation in patients not capable of totally spontaneous autonomous breathing. Am J Respir Crit Care Med 2001; 164:638–641.

    CAS  Article  Google Scholar 

  20. Chen J, Qiu D, Tao D. Time for extubation and sequential noninvasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation. Zhonghua Jie He He Hu Xi Za Zhi 2001; 24:99–100.

    CAS  PubMed  Google Scholar 

  21. Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 2016; 71(Suppl 2):ii1–ii35.

  22. Mishra M, Chaudhri S, Tripathi V, Verma AK, Sampath A, Chauhan NK. Weaning of mechanically ventilated chronic obstructive pulmonary disease patients by using non-invasive positive pressure ventilation: a prospective study. Lung India 2014; 31:127–133.

    Article  Google Scholar 

  23. Li PJ, Wang T, Xiao J, Jiang FM, Luo J, Shi CL, et al. Efficacy of two noninvasive weaning strategies in intubated patients with chronic obstructive pulmonary disease: A meta-analysis and indirect treatment comparison. Heart Lung 2016; 45:132–139.

    Article  Google Scholar 

  24. Zhu F, Liu ZL, Long X, Wu XD, Zhou J, Bai CX, et al. Effect of noninvasive positive pressure ventilation on weaning success in patients receiving invasive mechanical ventilation: a meta-analysis. Chin Med J (Engl) 2013; 126:1337–1343.

    Google Scholar 

  25. Wang C, Shang M, Huang K, Tong Z, Kong W, Jiang C, et al. Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure. Chin Med J (Engl) 2003; 116:39–43.

    Google Scholar 

  26. Kallet RH, Diaz JV. The physiologic effects of noninvasive ventilation. Respir Care 2009; 54: 102–115.

    Article  Google Scholar 

  27. Antonaglia V, Ferluga M, Capitanio G, Lucangelo U, Piller F, Roman-Pognuz E, et al. Respiratory mechanics in COPD patients who failed non-invasive ventilation: role of intrinsic PEEP. Respir Physiol Neurobiol 2012; 184:35–40.

    Article  Google Scholar 

  28. Torres A, Aznar R, Gatell JM, Jiménez P, González J, Ferrer A, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142: 523–528.

    CAS  Article  Google Scholar 

  29. Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med 2011; 37: 775–784.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tamer S. Fahmy MD, PhD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Moneim, S.A., Fahmy, T.S. & Abed, N. Predictors of failure of early shift from invasive to noninvasive ventilation in weaning chronic obstructive pulmonary disease patients who have failed the initial spontaneous breathing trial: a prospective cohort study. Egypt J Bronchol 12, 49–56 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words

  • airway resistance
  • early transition
  • lung mechanics
  • negative inspiratory pressure
  • rapid shallow breathing index
  • spontaneous breathing trail