title: Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation.
abstract: OBJECTIVE
  To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Medical intensive care units (ICUs) in a university health science center.
  
  
  METHODS
  Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs.
  
  
  METHODS
  Mechanical ventilation was delivered via a face mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of < 25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs.
  
  
  RESULTS
  Mechanical ventilation via face mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via face mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via face mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication.
  
  
  CONCLUSIONS
  We conclude that mechanical ventilation via face mask offers an effective, comfortable, and dignified method of supporting patients with end-stage disease and acute respiratory failure.
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: G U
authors.initials: GU
authors.lastname: Meduri
authors.forename: R C
authors.initials: RC
authors.lastname: Fox
authors.forename: N
authors.initials: N
authors.lastname: Abou-Shala
authors.forename: K V
authors.initials: KV
authors.lastname: Leeper
authors.forename: R G
authors.initials: RG
authors.lastname: Wunderink
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003422:Critical Care; D006801:Humans; D007442:Intubation, Intratracheal; D008397:Masks; D008875:Middle Aged; D011379:Prognosis; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016312:Treatment Refusal