| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Department of Medicine, Pulmonary and Critical Care Division, the University of Tennessee Medical Center, Regional Medical Center, and Veteran Affairs Medical Center, Memphis
2 From the Department of Preventive Medicine, Division of Biostatistics and Epidemiology, the University of Tennessee Medical Center, Regional Medical Center, and Veteran Affairs Medical Center, Memphis
Objectives: We have previously reported our experience with noninvasive positive pressure ventilation (NPPV) via face mask in a small group of selected patients with acute respiratory failure (ARF). NPPV was frequently effective (70% success rate) in correcting gas exchange abnormalities and in avoiding endotracheal intubation (ETI); NPPV also had a low rate of complications. We have evaluated the clinical application of NPPV as first-line intervention in patients with hypercapnic and short-term hypoxemic ARF. A dedicated respiratory therapist conducted an educational program with physicians-in-training rotating through the medical ICUs of a university medical center and supervised implementation of a simplified management protocol. Over 24 months, 164 patients with heterogeneous forms of ARF received NPPV. We report on the effectiveness of NPPV in correcting gas exchange abnormalities, in avoiding ETI, and associated complications, in different conditions precipitating ARF.
Patient population: One hundred fifty-eight patients completed the study. Forty-one had hypoxemic ARF, 52 had hypercapnic ARF, 22 had hypercapnic acute respiratory insufficiency (ARI), 17 had other forms of ARF, and 26 with advanced illness had ARF and refused intubation. Twenty-five percent of the patients developed ARF after extubation.
Intervention: Mechanical ventilation was delivered via a face mask. Initial ventilatory settings were continuous positive airway pressure (CPAP) mode, 5 cm H2O, with pressure support ventilation of 10 to 20 cm H2O titrated to achieve a respiratory rate less than 25 breaths/min and an exhaled tidal volume of 7 mL/kg or more. Ventilator settings were adjusted following arterial blood gases (ABG) results.
Results: The mean duration of NPPV was 25±24 h. When the 26 patients with advanced illness are excluded, NPPV was effective in improving or correcting gas exchange abnormalities in 105 patients (80%) and avoiding ETI in 86 (65%). Failure to improve ABG values was the reason for ETI in 20 of 46 (43%). The overall average predicted and actual mortality were 32% and 16%, respectively. Survival was 93% in nonintubated patients and 79% in intubated patients. NPPV was effective in lessening dyspnea throughout treatment in all but seven patients. Complications developed in 24 patients (16%). In patients with hypercapnic ARF, nonresponders had a higher PaCO2 at entrance (91.5±4.2 vs 80±1.5; p<0.01). In patients with hypercapnic ARF and ARI, arterial blood gases response (pH and PaCO2) within 2 h of NPPV predicted success (p<0.0001). None of the entrance parameters predicted need for ETI.
Conclusions: We conclude that application of NPPV in clinical practice is an effective and safe alternative to ETI in many hemodynamically stable patients with hypercapnic ARF and in those with hypoxemic ARF in whom the clinical condition can be readily reversed in 48 to 72 h. An educational and supervision program is essential to successfully implement this form of therapy.
Key Words: asthma • chronic obstructive pulmonary disease • dyspnea • outcome • hypercapnia • hypoxemia • intensive care unit • intermittent positive pressure ventilation • mechanical ventilation • noninvasive ventilation • respiratory insufficiency
Submitted on April 13, 1995
Accepted on August 22, 2007
This article has been cited by other articles:
|
|
 |
|
  J. Sancho, E. Servera, N. S. Hill, E. Garpestad, and J. Brennan Noninvasive Ventilation for Patients With Neuromuscular Disease and Acute Respiratory Failure Chest, January 1, 2008; 133(1): 314 - 315. [Full Text] [PDF]
|
|
|
|
|
|
E. Garpestad, J. Brennan, and N. S. Hill Noninvasive Ventilation for Critical Care Chest, August 1, 2007; 132(2): 711 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Balami, S. M. Packham, and M. A. Gosney Non-invasive ventilation for respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease in older patients Age Ageing, January 1, 2006; 35(1): 75 - 79. [Full Text] [PDF]
|
|
|
|
|
|
T. Honrubia, F. J. Garcia Lopez, N. Franco, M. Mas, M. Guevara, M. Daguerre, I. Alia, A. Algora, P. Galdos, and on Behalf of the EMVIRA Investigators Noninvasive vs Conventional Mechanical Ventilation in Acute Respiratory Failure: A Multicenter, Randomized Controlled Trial Chest, December 1, 2005; 128(6): 3916 - 3924. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Pasquina, P. Merlani, J. M. Granier, and B. Ricou Continuous Positive Airway Pressure Versus Noninvasive Pressure Support Ventilation to Treat Atelectasis After Cardiac Surgery Anesth. Analg., October 1, 2004; 99(4): 1001 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. T. Cheung, L. Y. C. Yam, L. K. Y. So, A. C. W. Lau, E. Poon, B. M. H. Kong, and R. W. H. Yung Effectiveness of Noninvasive Positive Pressure Ventilation in the Treatment of Acute Respiratory Failure in Severe Acute Respiratory Syndrome Chest, September 1, 2004; 126(3): 845 - 850. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Paus-Jenssen, J. K. Reid, D. W. Cockcroft, K. Laframboise, and H. A. Ward The Use of Noninvasive Ventilation in Acute Respiratory Failure at a Tertiary Care Center Chest, July 1, 2004; 126(1): 165 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.W. Elliott The interface: crucial for successful noninvasive ventilation Eur. Respir. J., January 1, 2004; 23(1): 7 - 8. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ferrer, A. Esquinas, M. Leon, G. Gonzalez, A. Alarcon, and A. Torres Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure: A Randomized Clinical Trial Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1438 - 1444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Liesching, H. Kwok, and N. S. Hill Acute Applications of Noninvasive Positive Pressure Ventilation Chest, August 1, 2003; 124(2): 699 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Soroksky, D. Stav, and I. Shpirer A Pilot Prospective, Randomized, Placebo-Controlled Trial of Bilevel Positive Airway Pressure in Acute Asthmatic Attack Chest, April 1, 2003; 123(4): 1018 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Rello, M. Bodi, D. Mariscal, M. Navarro, E. Diaz, M. Gallego, and J. Valles Microbiological Testing and Outcome of Patients With Severe Community-Acquired Pneumonia Chest, January 1, 2003; 123(1): 174 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Phipps and C S Garrard The pulmonary physician in critical care * 12: Acute severe asthma in the intensive care unit Thorax, January 1, 2003; 58(1): 81 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Gehlbach, J. P. Kress, J. Kahn, C. DeRuiter, A. Pohlman, and J. Hall Correlates of Prolonged Hospitalization in Inner-city ICU Patients Receiving Noninvasive and Invasive Positive Pressure Ventilation for Status Asthmaticus Chest, November 1, 2002; 122(5): 1709 - 1714. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Schonhofer and S. Sortor-Leger Equipment needs for noninvasive mechanical ventilation Eur. Respir. J., October 1, 2002; 20(4): 1029 - 1036. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Keenan, C. Powers, D. G. McCormack, and G. Block Noninvasive Positive-Pressure Ventilation for Postextubation Respiratory Distress: A Randomized Controlled Trial JAMA, June 26, 2002; 287(24): 3238 - 3244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.W. Elliott, M. Confalonieri, and S. Nava Where to perform noninvasive ventilation? Eur. Respir. J., June 1, 2002; 19(6): 1159 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Elliott and N. Ambrosino Noninvasive ventilation: a decade of progress Eur. Respir. J., April 1, 2002; 19(4): 587 - 589. [Full Text] [PDF]
|
|
|
|
|
|
Non-invasive ventilation in acute respiratory failure Thorax, March 1, 2002; 57(3): 192 - 211. [Full Text] [PDF]
|
|
|
|
|
|
D. Cook, M. Meade, G. Guyatt, R. Butler, A. Aldawood, and S. Epstein Trials of Miscellaneous Interventions to Wean From Mechanical Ventilation Chest, December 1, 2001; 120(6_suppl): 438S - 444S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C. GAY, D. R. HESS, and N. S. HILL Noninvasive Proportional Assist Ventilation for Acute Respiratory Insufficiency . Comparison with Pressure Support Ventilation Am. J. Respir. Crit. Care Med., November 1, 2001; 164(9): 1606 - 1611. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P K Plant, J L Owen, and M W Elliott Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome Thorax, September 1, 2001; 56(9): 708 - 712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wysocki and M. Antonelli Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure Eur. Respir. J., July 1, 2001; 18(1): 209 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Lessard Noninvasive ventilation in the ICU / La ventilation non invasive aux soins intensifs Can J Anesth, June 1, 2001; 48(90001): R2 - 2. [Full Text] [PDF]
|
|
|
|
|
|
D. C. McCrory, C. Brown, S. E. Gelfand, and P. B. Bach Management of Acute Exacerbations of COPD : A Summary and Appraisal of Published Evidence Chest, April 1, 2001; 119(4): 1190 - 1209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. CARLUCCI, J.-C. RICHARD, M. WYSOCKI, E. LEPAGE, L. BROCHARD, and the SRLF Collaborative Group o Noninvasive Versus Conventional Mechanical Ventilation . An Epidemiologic Survey Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 874 - 880. [Abstract] [Full Text]
|
|
|
|
 |
|
 G. Hilbert, D. Gruson, F. Vargas, R. Valentino, G. Gbikpi-Benissan, M. Dupon, J. Reiffers, and J. P. Cardinaud Noninvasive Ventilation in Immunosuppressed Patients with Pulmonary Infiltrates, Fever, and Acute Respiratory Failure N. Engl. J. Med., February 15, 2001; 344(7): 481 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. MEHTA and N. S. HILL Noninvasive Ventilation Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 540 - 577. [Full Text]
|
|
|
|
|
|
International Consensus Conferences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure . Organized Jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000 Am. J. Respir. Crit. Care Med., January 1, 2001; 163(1): 283 - 291. [Full Text]
|
|
|
|
|
|
E. Girou, F. Schortgen, C. Delclaux, C. Brun-Buisson, F. Blot, Y. Lefort, F. Lemaire, and L. Brochard Association of Noninvasive Ventilation With Nosocomial Infections and Survival in Critically Ill Patients JAMA, November 8, 2000; 284(18): 2361 - 2367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Sinuff, D. Cook, J. Randall, and C. Allen Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital Can. Med. Assoc. J., October 1, 2000; 163(8): 969 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J V J LIGHTOWLER and M W ELLIOTT Predicting the outcome from NIV for acute exacerbations of COPD Thorax, October 1, 2000; 55(10): 815 - 816. [Full Text]
|
|
|
|
|
|
M. Moretti, C. Cilione, A. Tampieri, C. Fracchia, A. Marchioni, and S. Nava Incidence and causes of non-invasive mechanical ventilation failure after initial success Thorax, October 1, 2000; 55(10): 819 - 825. [Abstract] [Full Text]
|
|
|
|
|
|
W. M. COPLIN, D. J. PIERSON, K. D. COOLEY, D. W. NEWELL, and G. D. RUBENFELD Implications of Extubation Delay in Brain-Injured Patients Meeting Standard Weaning Criteria Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1530 - 1536. [Abstract] [Full Text]
|
|
|
|
|
|
S. JABER, R. FODIL, A. CARLUCCI, M. BOUSSARSAR, J. PIGEOT, F. LEMAIRE, A. HARF, F. LOFASO, D. ISABEY, and L. BROCHARD Noninvasive Ventilation with Helium-Oxygen in Acute Exacerbations of Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 2000; 161(4): 1191 - 1200. [Abstract] [Full Text]
|
|
|
|
|
|
A. M. Karnik Noninvasive Positive Pressure Ventilation : Testing the Bridge Chest, March 1, 2000; 117(3): 625 - 627. [Full Text] [PDF]
|
|
|
|
|
|
A. Anton, R. Guell, J. Gomez, J. Serrano, A. Castellano, J. L. Carrasco, and J. Sanchis Predicting the Result of Noninvasive Ventilation in Severe Acute Exacerbations of Patients With Chronic Airflow Limitation Chest, March 1, 2000; 117(3): 828 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Cross Review of the role of non-invasive ventilation in the emergency department Emerg. Med. J., March 1, 2000; 17(2): 79 - 85. [Full Text]
|
|
|
|
|
|
M. Antonelli, G. Conti, M. Bufi, M. G. Costa, A. Lappa, M. Rocco, A. Gasparetto, and G. U. Meduri Noninvasive Ventilation for Treatment of Acute Respiratory Failure in Patients Undergoing Solid Organ Transplantation: A Randomized Trial JAMA, January 12, 2000; 283(2): 235 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. CONFALONIERI, A. POTENA, G. CARBONE, R. D. PORTA, E. A. TOLLEY, and G. UMBERTO MEDURI Acute Respiratory Failure in Patients with Severe Community-acquired Pneumonia . A Prospective Randomized Evaluation of Noninvasive Ventilation Am. J. Respir. Crit. Care Med., November 1, 1999; 160(5): 1585 - 1591. [Abstract] [Full Text]
|
|
|
|
|
|
I. A. Munshi, B. DeHaven, O. Kirton, D. Sleeman, and M. Navarro Reengineering Respiratory Support Following Extubation: Avoidance of Critical Care Unit Costs Chest, October 1, 1999; 116(4): 1025 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. GIRAULT, I. DAUDENTHUN, V. CHEVRON, F. TAMION, J. LEROY, and G. BONMARCHAND 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., July 1, 1999; 160(1): 86 - 92. [Abstract] [Full Text]
|
|
|
|
|
|
J. H. Hertzog, L. B. Siegel, G. J. Hauser, and H. J. Dalton Noninvasive Positive-Pressure Ventilation Facilitates Tracheal Extubation After Laryngotracheal Reconstruction in Children Chest, July 1, 1999; 116(1): 260 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Rocker, M.-G. Mackenzie, B. Williams, and P. M. Logan Noninvasive Positive Pressure Ventilation: Successful Outcome in Patients With Acute Lung Injury/ARDS Chest, January 1, 1999; 115(1): 173 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nava, M. Confalonieri, and C. Rampulla Intermediate respiratory intensive care units in Europe: a European perspective Thorax, September 1, 1998; 53(9): 798 - 802. [Full Text]
|
|
|
|
|
|
M. Antonelli, G. Conti, M. Rocco, M. Bufi, R. A. De Blasi, G. Vivino, A. Gasparetto, and G. U. Meduri A Comparison of Noninvasive Positive-Pressure Ventilation and Conventional Mechanical Ventilation in Patients with Acute Respiratory Failure N. Engl. J. Med., August 13, 1998; 339(7): 429 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Hillberg and D. C. Johnson Noninvasive Ventilation N. Engl. J. Med., December 11, 1997; 337(24): 1746 - 1752. [Full Text] [PDF]
|
|
|
|
|
|
O Diaz, R Iglesia, M Ferrer, E Zavala, C Santos, P. Wagner, J Roca, and R Rodriguez- Roisin Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease Am. J. Respir. Crit. Care Med., December 1, 1997; 156(6): 1840 - 1845. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. R Baldwin and M. B Allen Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease BMJ, January 18, 1997; 314(7075): 163 - 163. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
