Zimnoch Mary, Eldeiry David, Aruleba Oluwabunmi, Schwartz Jacob, Avaricio Michael, Ishikawa Oki, Mina Bushra, Esquinas Antonio
Department of Pulmonary & Critical Care Medicine, Northwell Lenox Hill Hospital, New York, NY 10075, USA.
Department of Pulmonary & Critical Care Medicine, Northwell Northern Westchester Hospital, New York, NY 10549, USA.
J Clin Med. 2025 Jul 16;14(14):5033. doi: 10.3390/jcm14145033.
Non-invasive ventilation (NIV) is a cornerstone in the management of acute and chronic respiratory failure, offering critical support without the risks of intubation. However, successful weaning from NIV remains a complex, high-stakes process. Poorly timed or improperly executed weaning significantly increases morbidity and mortality, yet current clinical practice often relies on subjective judgment rather than evidence-based protocols. This manuscript reviews the current landscape of NIV weaning, emphasizing structured approaches, objective monitoring, and predictors of weaning success or failure. It examines guideline-based indications, monitoring strategies, and various weaning techniques-gradual and abrupt-with evidence of their efficacy across different patient populations. Predictive tools such as the Rapid Shallow Breathing Index, Lung Ultrasound Score, Diaphragm Thickening Fraction, ROX index, and HACOR score are analyzed for their diagnostic value. Additionally, this review underscores the importance of care setting-ICU, step-down unit, or general ward-and how it influences outcomes. Finally, it highlights critical gaps in research, especially around weaning in non-ICU environments. By consolidating current evidence and identifying predictors and pitfalls, this article aims to support clinicians in making safe, timely, and patient-specific NIV weaning decisions. In the current literature, there are gaps regarding patient selection and lack of universal protocolization for initiation and de-escalation of NIV as the data has been scattered. This review aims to consolidate the relevant information to be utilized by clinicians throughout multiple levels of care in all hospital systems.
无创通气(NIV)是急性和慢性呼吸衰竭管理的基石,提供关键支持且无插管风险。然而,成功撤机NIV仍然是一个复杂、高风险的过程。撤机时机不当或执行不当会显著增加发病率和死亡率,但目前的临床实践往往依赖主观判断而非循证方案。本文综述了NIV撤机的现状,强调结构化方法、客观监测以及撤机成功或失败的预测因素。它研究了基于指南的指征、监测策略以及各种撤机技术——渐进式和突然式——及其在不同患者群体中的疗效证据。分析了快速浅呼吸指数、肺部超声评分、膈肌增厚分数、ROX指数和HACOR评分等预测工具的诊断价值。此外,本综述强调了护理环境——重症监护病房、过渡病房或普通病房——的重要性以及它如何影响结果。最后,它突出了研究中的关键差距,特别是在非重症监护病房环境中的撤机方面。通过整合现有证据并确定预测因素和陷阱,本文旨在支持临床医生做出安全、及时且针对患者的NIV撤机决策。在当前文献中,关于患者选择存在差距,并且由于数据分散,NIV启动和降级缺乏通用的方案制定。本综述旨在整合相关信息,供所有医院系统各级护理的临床医生使用。