title: Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation.
abstract: OBJECTIVE
  To investigate the effects of noninvasive positive pressure ventilation (NPPV) on pulmonary gas exchange, breathing pattern, intrapulmonary shunt fraction, oxygen consumption, and resting energy expenditure in patients with persistent acute respiratory failure but without chronic obstructive pulmonary disease (COPD) after early extubation.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Multidisciplinary intensive care unit of a university hospital.
  
  
  METHODS
  15 patients after prolonged mechanical ventilation (> 72 h) with acute respiratory insufficiency after early extubation.
  
  
  METHODS
  Criteria for early extubation were arterial oxygen tension (PaO2) > or = 40 mm Hg (fractional inspired oxygen 0.21), arterial carbon dioxide tension (PaCO2) < or = 55 mm Hg, pH > 7.32, respiratory rate < or = 40 breaths per min, tidal volume (VT) > or = 3 ml/kg, rapid shallow breathing index < or = 190 and negative inspiratory force > or = 20 cmH2O. After extubation, two modes of NPPV were applied [continuous positive airway pressure (CPAP) of 5 cmH2O and pressure support ventilation (PSV) with 15 cmH2O pressure support].
  
  
  RESULTS
  Oxygenation and ventilatory parameters improved during both modes of NPPV (p < 0.05): increase in PaO2 of 11 mm Hg during CPAP and 21 mm Hg during PSV; decrease in intrapulmonary shunt fraction of 7% during CPAP and 12% during PSV; increase in tidal volume of 1 ml/kg during CPAP and 4 ml/kg during PSV; decrease in respiratory rate 6 breaths/min during CPAP and 9 breaths/min during PSV. Oxygen consumption (15% during CPAP, 22% during PSV) and resting energy expenditure (12% during CPAP, 20% during PSV) were reduced (p < 0.05). PaCO2 decreased, whereas minute ventilation and pH increased during PSV (p < 0.05). The median duration of NPPV was 2 days. Two patients had to be reintubated.
  
  
  CONCLUSIONS
  In non-COPD patients with persistent acute respiratory failure after early extubation, NPPV improved pulmonary gas exchange and breathing pattern, decreased intrapulmonary shunt fraction, and reduced the work of breathing.
authors.affiliation: Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Kilger
authors.forename: J
authors.initials: J
authors.lastname: Briegel
authors.forename: M
authors.initials: M
authors.lastname: Haller
authors.forename: L
authors.initials: L
authors.lastname: Frey
authors.forename: G
authors.initials: G
authors.lastname: Schelling
authors.forename: C
authors.initials: C
authors.lastname: Stoll
authors.forename: B
authors.initials: B
authors.lastname: Pichler
authors.forename: K
authors.initials: K
authors.lastname: Peter
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D004734:Energy Metabolism; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012119:Respiration; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D015300:Ventilator Weaning