Treatment of acute exacerbations of chronic respiratory failure: integrated use of negative pressure ventilation and noninvasive positive pressure ventilation.
OBJECTIVE
Acute respiratory failure (ARF) can be treated with either invasive mechanical ventilation (IMV) or noninvasive mechanical ventilation (NIMV), which can spare the complications of artificial airways. To evaluate the efficacy of an integrated approach using negative pressure ventilation (NPV) with iron lung and noninvasive positive pressure ventilation (NPPV), we performed a prospective study in a group of patients admitted to our respiratory ICU (RICU) for ARF due to exacerbation of chronic respiratory failure (CRF).


METHODS
RICU at "R. Silvestrini" Hospital in Perugia, Italy.


METHODS
One hundred fifty-two consecutive patients were included in the study and treated with iron lung as first choice or, when contraindicated or not tolerated, with NPPV using a nasal or facial mask. After 2 h of noninvasive mechanical ventilation (NIMV), the patients were reevaluated; in case of clinical deterioration, patients receiving NPV were switched to NPPV. When NPPV as a first or second line of treatment failed the patients were intubated.


RESULTS
One hundred fifty-two patients received NIMV, 97 with iron lung as the first choice of treatment, and 55 with NPPV. Six patients treated with NPV were switched to NPPV during the first 2 h of treatment. Twenty-five patients required IMV. The success rate of the integrated use of NIMV (NPV plus NPPV) was 81.6%, compared to that of NPV (83.5%) and NPPV (70.5%). Twenty-one patients (13.8%) required tracheostomy; the duration of hospital stay was significantly lower in patients treated with NIMV only. Thirty patients required mechanical ventilation at home. Few severe complications were observed in patients receiving IMV.


CONCLUSIONS
The integrated use of two NIMV techniques is effective in patients with acute exacerbation of CRF. In most cases intubation and tracheostomy were avoided, thus reducing the complication rate of mechanical ventilation.
Todisco
Tommaso
T
Pulmonary Division and Respiratory ICU, R. Silvestrini Hospital, Perugia. Baglioni5@tin.it
Baglioni
Stefano
S
Eslami
Amir
A
Scoscia
Elvio
E
Todisco
Cristina
C
Bruni
Lucio
L
Dottorini
Maurizio
M
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D015919:Ventilators, Negative-Pressure