Noninvasive positive pressure ventilation treatment for acute respiratory failure in SARS.
This study describes the blood gases features and short-term outcomes with noninvasive positive pressure ventilation (NPPV) treatment in the management of acute respiratory failure (ARF) during a severe acute respiratory syndrome (SARS) epidemic. Between April 22 and May 1, 2003, 120 patients meeting clinical criteria for SARS were admitted to a hospital for infectious diseases in Beijing, China. At 6 weeks after onset, 25% of patients (30/120) had experienced ARF. Of interest, 16 of these patients (53%) exhibited hypercapnia (PaCO (2) > 45 mm Hg), and 10 hypercapnic events occurred within 1 week of admission. The occurence of hypencapnia or CO (2) retention and was accompanied by myalgias. NPPV was instituted in 28 patients; one was intolerant of NPPV. In the remaining 27 patients, NPPV was initiated 1.2 +/- 1.6 days after ARF onset. An hour of NPPV therapy led to significant increases in PaO (2) and PaO (2)/FiO (2) and a decrease in respiratory rate ( p < 0.01). Endotracheal intubation was required in one third of the patients (9 of 27) who initially had a favorable response to NPPV. Remarkable pulmonary barotrauma was noticed in 7 of all 120 patients (5.8%) and in 6 of those (22%) on NPPV. The overall fatality rate at 13 weeks was 6.7% (8/120); it was higher (26.7%) in those needing NPPV. No caregiver contracted SARS. We conclude that NPPV is a feasible and appropriate treatment for ARF occurring as a result of a SARS infection.
Han
Fang
F
Department of Pulmonary Medicine, the People's Hospital, Beijing University, Beijing, China. hanfang1@hotmail.com
Jiang
Yu Y
YY
Zheng
Jian H
JH
Gao
Zhan C
ZC
He
Quan Y
QY
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D045169:Severe Acute Respiratory Syndrome / Q000150:complications*; D012720:Severity of Illness Index