[Limitations of noninvasive mask ventilation in acute hypoxemic gas exchange disorders (COPD)].
The benefit of noninvasive mask ventilation (NIMV) compared to mechanical ventilation after intubation is proven in patients with acute exacerbation of COPD. Contrary to this point the benefit is not clear in patients with acute gas exchange failure, such as in pneumonias. We tried to evaluate the efficiency of NIMV in this indication in a clinical case series. We treated 31 patients with acute gas exchange failure (pO2 52 +/- 11 Torr, APACHE II Score 20 +/- 7) with NIMV. In 18 patients (58%) blood gases improved. But during the further course 2 patients were intubated, 3 patients died. In 13 patients mask ventilation was stopped because of ineffectivity. 11 patients were intubated, 8 patients died. 3 patients were not intubated for ethical reasons. The success rate is about 20% lower than in patients with acute ventilatory insufficiency. NIMV can be used in patients with severe gas exchange failure. Until now, however, no data are available proving that the method offers significant advantages over intubation and mechanical ventilation.
Karg
O
O
Zentrum für Pneumologie und Thoraxchirurgie, Fachklinik München-Gauting.
Bullemer
F
F
HeindlS
D018806:APACHE; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007440:Intubation; D017214:Laryngeal Masks; D008173:Lung Diseases, Obstructive / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial
D002245:Carbon Dioxide; D010100:Oxygen