What is the role of postextubation NPPV for patients with COPD exacerbations who are intubated because they were not initially candidates for NPPV? I. earlier extubation to NPPV II. reduced incidence of nosocomial infection III. decreased length of stay in hospital IV. shortened duration of positive-pressure mechanical ventilation

A. I. only
B. II, III only
C. I, III, IV only
D. I, II, III, IV only

ANS: D (page 367)
Cognitive Level: Recall
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: When patients with COPD exacerbations are intubated because they are not candidates for NPPV initially or because they fail a trial of NPPV, multiple studies have demonstrated that NPPV can be used to permit earlier extubation, even if these patients have failed multiple T-piece weaning trials. Early extubation to NPPV increases eventual weaning rate, shortens the duration of ventilator use and hospital length of stay, reduces the occurrence of nosocomial infection, and reduces mortality.