Noninvasive positive pressure ventilation in patients with respiratory failure due to severe acute pancreatitis.
BACKGROUND
Patients with acute pancreatitis (AP) who require mechanical ventilation have high morbidity and mortality rates. Noninvasive positive pressure ventilation (NPPV) delivered through a mask has become increasingly popular for the treatment of acute respiratory failure (ARF) and may limit some mechanical ventilation complications.


OBJECTIVE
The purpose of this retrospective, observational study was to evaluate our clinical experience with the use of NPPV in AP patients with ARF.


METHODS
From 1997 to 2003, we documented clinical data, gas exchange and outcome of the 62 AP patients admitted to our intensive care unit. Patients who benefited from NPPV (success) were compared with those who failed (intubated).


RESULTS
Twenty-nine patients were intubated at admission and 5 did not develop ARF. Of the 28 patients treated with NPPV, 15 were not intubated (54%). Both groups had a similar PaO(2)/FiO(2) ratio (142 +/- 21 vs. 133 +/- 20; p = 0.127) and severity of illness (Ranson and Balthazar scores). Presence of atelectasis, bilateral alveolar infiltrates and abdominal distension were associated with failure of NPPV. Oxygenation improved and respiratory rate decreased significantly only in the success group. Additionally, the length of stay at the intensive care unit was significantly lower in the success group.


CONCLUSIONS
NPPV is feasible and safe to treat ARF in selected patients with AP who require ventilatory support.
Jaber
Samir
S
Critical Care and Anesthesiology Department, DAR B, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France. s-jaber@chu-montpellier.fr
Chanques
Gérald
G
Sebbane
Mustapha
M
Salhi
Farida
F
Delay
Jean-Marc
JM
Perrigault
Pierre-François
PF
Eledjam
Jean-Jacques
JJ
D000005:Abdomen / Q000503:physiopathology; D000208:Acute Disease; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000503:physiopathology; D001261:Pulmonary Atelectasis / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome