Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients.
OBJECTIVE
To test whether non-invasive ventilation via facial mask could reduce the need for tracheal intubation when mechanical ventilation must be initiated in COPD patients.


METHODS
Open prospective interventional study.


METHODS
General Intensive Care Service of a County Hospital.


METHODS
We have studied 12 COPD patients during 14 episodes of acute exacerbation of chronic respiratory failure who failed to improve with intensive medical therapy and showed impairments in severe respiratory acidosis and/or hypercapnic encephalopathy leading their attending physicians to order mechanical ventilation.


METHODS
In these circumstances, a trial of pressure-support (PS) ventilation (Servo Ventilator 900C) via facial mask Vital Signs Inc.) was performed. The level of pressure support was adjusted to obtain a tidal volume > 400 ml. If the patient deteriorated, tracheal intubation and standard mechanical ventilation were performed.


RESULTS
Measurements are presented as means +/- SEM. A pressure-support level of 14 +/- 3 cmH2O was used during a period of 8 +/- 4 h. Low levels of external PEEP were used in 4 patients, while it generated excessive leaks in the others. Significant differences (p < 0.05 ANOVA for repeated measures) in data obtained on admission, when patients deteriorated and after pressure support was administered were only observed in PaCO2 (68 +/- 3 versus 92 +/- 3 versus 67 +/- 3 mmHg), arterial pH (7.27 +/- 0.03 versus 7.19 +/- 0.02 versus 7.31 +/- 0.01). SaO2 (60 +/- 4 versus 86 +/- 3 versus 92 +/- 1%) and respiratory rate (35 +/- 2 versus 32 +/- 2 versus 23 +/- 1 breaths.min-1). Three patients needed intubation and one of them died in the ICU.


CONCLUSIONS
Non-invasive ventilation (pressure-support) via face mask may reduce the need for tracheal intubation in the severe hypercapnic failure of COPD patients.
Fernandez
R
R
Intensive Care Service, Hospital de Sabadell, Sabadell, Spain.
Blanch
L
L
Valles
J
J
Baigorri
F
F
Artigas
A
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000150:complications* / Q000209:etiology; D007442:Intubation, Intratracheal; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008297:Male; D008397:Masks; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome