Non-invasive pressure support ventilation in acute hypoxemic (non hypercapnic) respiratory failure. Observations in Respiratory Intermediate Intensive Care Unit.
BACKGROUND
Non-invasive positive pressure support ventilation (NIPSV).


METHODS
In patients with acute hypoxaemic (PaO2/FiO2 &Mac178;100) non hypercapnic respiratory failure (ARF) admitted to a Respiratory Inter-mediate Intensive Care Unit of a general Hospital, between January 1993 and December 1997.


RESULTS
In 21 selected patients (PaO2/ FiO2T0=82+/-9) NIPSV improved PaO2 in 13/21 patients (Group A) and did not improve in 8/21 patients (Group B) (PaO2/FiO2T1=154+/-25 in Group A vs PaO2/FiO2T1=106+/-7.5 in Group B, p=0.00001). Upon admission the two groups did neither significantly differ for blood gas values (PaO2/FiO2T0=84+/-9.6 in Group A vs 79.8+/-8.7 in Group B), nor for clinical status (APACHE II=19.8+/-5 in Group A vs 24.6+/-7 in Group B). Shorter duration of NIPSV in Group B patients (11.2+/-19.7 hrs vs 35.3+/-32.3 hrs in Group A, p=0.047), in spite of a rise in PEEP (9.3+/-2.3 in Group B vs 5.5+/-2.4 in Group A, p=0.003) and Pressure Support (18.7+/-1.8 in Group B vs 15+/-3.2 in Group A, p=0.004) was due to onset of conditions which required shifting from NIPSV to endotracheal intubation (ETI).


RESULTS
8/21 patients were successfully treated by only NIPSV. 8/21 patients were intubated. 5/21 patients dead in RIICU; 1 month survival: 9/21 patients. Side effects: mask intolerance (3/21); skin necrosis (1/21); pneumothorax (1/21).


CONCLUSIONS
NIPSV may be tried in ARF patients to improve PaO2 and avoid ETI.
Mollica
C
C
Azienda Ospedaliera, S. Camillo-Forlanini, STIRS, Rome, Italy.
Brunetti
G
G
Buscajoni
M
M
Cecchini
L
L
Maialetti
E
E
Marazzi
M
M
Principe
R
R
Sabato
R
R
Antonini
V E
VE
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000628:therapy; D000208:Acute Disease; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D003422:Critical Care / Q000379:methods*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008397:Masks; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000628:therapy; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000628:therapy; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy; D012131:Respiratory Insufficiency / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012384:Rome; D018805:Sepsis / Q000150:complications; D012770:Shock, Cardiogenic / Q000150:complications; D016019:Survival Analysis; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen