A unique use of endotracheal tube as a cuffed nasopharyngeal airway as an interface for noninvasive ventilation during weaning from mechanical ventilator

摘要

To address theseissues in our setup with resourcelimitation and economicconstraints, we developed a unique NIVinterface derived fromcuffed endotrachealtubeand effectively delivered NIVpostextubation to an elderly diabeticfemalein ICU, postlaparotomy following peritonitis. Although decision to extubate was taken afterensuring satisfactory hemodynamic parameters,afebrilestatus,asuccessfulspontaneous breathing trialfor 2 h on pressuresupport (PS) ventilation (PS: 5 cmH2O, PEEP: 5 cmH2O, FIO2: 0.4), PaO2/FIO2 ratio of 380, Rapid Shallow Breathing Index 73.6 and SpO294%, weanticipated extubation failurein viewof patient'sage, obesity, suboptimal glycemiccontrol,and marginally elevated intra-abdominal drain output. At thesametime, weintended to curtailthe number of days on invasive mechanical ventilation and prevent re-intubation. The design ofinterfaceascertained to avoid uncooperativeness,aerophagia, intra-abdominal hypertension,and consequent wound dehiscence. Hence,extubation to NIVwas planned, to serveasa back-up in case ofalikely respiratory failurefollowing extubation.