PROPHYLACTIC NON-INVASIVE POST-EXTUBATION VENTILATION IN OBESE PATIENTS

Abstract

Introduction: Prophylactic post-extubation non-invasive ventilation (NIV) has been investigated as an effective strategy to reduce respiratory complications in obese patients. These patients are at a higher risk of respiratory failure due to alterations in pulmonary mechanics, such as reduced lung compliance and increased airway resistance. Obesity is also associated with an elevated risk of hypoxemia and hypercapnia following endotracheal tube removal, which may lead to reintubation and prolonged intensive care unit (ICU) stays. In this context, NIV emerges as an alternative to improve the transition to spontaneous breathing while minimizing complications. However, further studies are needed to establish robust clinical guidelines for its application in obese patients.Objectives: This study aims to analyze scientific evidence regarding the efficacy and safety of prophylactic post-extubation NIV in obese patients, assessing its benefits in preventing respiratory complications. The specific objectives include: (a) investigating the main post-extubation respiratory complications in obese patients and how NIV can mitigate them; (b) reviewing comparative studies between NIV and other prophylactic respiratory interventions; and (c) identifying evidence-based protocols for the use of NIV in this population.Methodology: This study consists of a literature review conducted in the PubMed, SciELO, and LILACS databases, covering articles published between 2011 and 2024. Keywords such as "non-invasive ventilation," "extubation," "obese patients," and "respiratory complications" were used, combined with Boolean operators to refine the search. Studies published in Portuguese, English, and Spanish specifically addressing post-extubation NIV in obese patients were included. Studies on other respiratory interventions or those not involving the target population were excluded. The selected articles were analyzed based on their methodologies, results, limitations, and conclusions to support the discussion on NIV efficacy. Results: The analysis of selected studies demonstrated that prophylactic post-extubation NIV in obese patients is associated with better respiratory outcomes. Conclusion: Prophylactic post-extubation NIV proved effective in reducing respiratory complications in obese patients, with significant benefits in preventing reintubation and improving ventilatory mechanics. However, its application requires individualization, considering factors such as patient tolerance and proper adjustment of ventilatory parameters. Despite favorable evidence, the lack of standardized protocols highlights the need for further studies to establish specific clinical guidelines for this population.