title: An evaluation of the role of noninvasive positive pressure ventilation in the management of acute respiratory failure in a developing country.
abstract: OBJECTIVE
  Noninvasive positive pressure ventilation (NIPPV) has been shown to decrease the need for invasive mechanical ventilation (MV) in patients presenting with acute respiratory failure (ARF). We conducted a prospective study to assess if NIPPV use, in a developing country, was associated with clinical and physiological improvements.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Forty patients admitted to a medical intensive care unit during a 2-year period who fulfilled criteria for inclusion formed the study cohort to receive NIPPV.
  
  
  RESULTS
  Baseline (mean +/- SD) pH, PaCO 2 and PaO 2 were 7.25 +/- 0.08, 76.6 +/- 20.9 and 79.18 +/- 40.56 mmHg respectively. The primary indication for NIPPV was hypercapnic respiratory failure (n = 36, 90%). The success rate with NIPPV was 85%, with 34 of 40 patients weaned successfully. Significant improvements were observed at 1 hour following institution of NIPPV in pH (7.31 +/- 0.09, P 2 (65 +/- 17.9, P 2 54.7 +/- 20) and maintained (within 12 h) postweaning from the ventilator (pH 7.39 +/- 0.08, PaCO 2 51.9 +/- 12.4). No significant change in the PaO 2 was observed during NIPPV; PaO 2 after 1 h, prior to weaning and after weaning was 90.53 +/- 42.85, 84.80 +/- 33.76, 78.71 +/- 43.81 respectively.
  
  
  CONCLUSIONS
  This study has demonstrated benefits of NIPPV in avoiding the need for invasive MV in patients presenting with ARF of diverse etiology, with results comparable to developed nations. Increased use of NIPPV in ARF is likely to impact favorably in nations with limited resources.
authors.affiliation: Department of Medicine, Christian Medical College and Hospital, Ida Scudder Road, Vellore, India. igepreeta@cmcvellore.ac.in
authors.forename: Ige Abraham
authors.initials: IA
authors.lastname: George
authors.forename: George
authors.initials: G
authors.lastname: John
authors.forename: Preeta
authors.initials: P
authors.lastname: John
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
authors.forename: Solomon
authors.initials: S
authors.lastname: Christopher
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D055815:Young Adult