title: Protocol-based noninvasive positive pressure ventilation for acute respiratory failure.
abstract: OBJECTIVE
  Noninvasive positive pressure ventilation (NPPV) has been suggested to be associated with adverse outcomes in emergency patients with acute respiratory failure (ARF), possibly because of a delay in tracheal intubation (TI). We hypothesized that protocol-based NPPV (pNPPV) might improve the outcomes, compared with individual physician-directed NPPV (iNPPV).
  
  
  METHODS
  To guide decision making regarding the use of NPPV, we developed an NPPV protocol. Observational data were collected before and after protocol implementation in consecutive patients with ARF and compared between the pNPPV and the iNPPV groups.
  
  
  RESULTS
  The results for pNPPV (n = 37) were compared with those for iNPPV (n = 37). No significant baseline differences in patient characteristics were observed between the two groups except for mean age, which was higher in the pNPPV group than in the iNPPV group (P = 0.02). Rate of TI and duration of mechanical ventilation were similar in the two groups. However, the time from the start of NPPV until TI tended to be shorter in the pNPPV group than in the iNPPV group (P = 0.11). The hospital mortality rate was significantly lower in the pNPPV group than in the iNPPV group (P = 0.049). Although the length of hospital stay was shorter in the pNPPV group than in the iNPPV group, this trend did not reach statistical significance (P = 0.14).
  
  
  CONCLUSIONS
  The present study suggests that pNPPV is effective and likely to improve the mortality rate of emergency patients with ARF.
authors.affiliation: Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. chuukiku@m3.kufm.kagoshima-u.ac.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toba
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Iwashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Masatomo
authors.initials: M
authors.lastname: Kitamura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nitta
authors.forename: Katsunori
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Okamoto
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002138:Calibration; D002985:Clinical Protocols; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D058996:Quality Improvement; D012131:Respiratory Insufficiency / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D016896:Treatment Outcome; D015300:Ventilator Weaning