Chest
Volume 103, Issue 3, March 1993, Pages 907-913
Journal home page for Chest

Clinical Investigations in Critical Care
Noninvasive Pressure Support Ventilation in Patients With Acute Respiratory Failure

https://doi.org/10.1378/chest.103.3.907Get rights and content

To further delineate indications for noninvasive pressure support ventilation (NIPSV), we proposed this noninvasive technique as an alternative to endotracheal intubation in 17 consecutive patients with acute respiratory failure from various causes. Eight patients (47 percent) were successfully ventilated with NIPSV, while in 9 (53 percent), NIPSV failed. Gas exchange values before initiating NIPSV were different between the 2 groups: patients successfully ventilated with NIPSV had a higher PaCO2 (57 ± 15 mm Hg vs 37 ± 17 mm Hg; p=0.01), a lower pH (7.33 ± 0.03 vs 7.45 ± 0.08; p=0.02), and a lower alveolo-arterial oxygen pressure difference (P[A-a]O2) (144 ± 46 mm Hg vs 265 ± 18 mm Hg; p=0.01), suggesting that CO, retention without major hypoxemia is a better indication for NIPSV than severe hypoxemia alone. Acute respiratory failure occurring after extubation seemed to be a good indication for NIPSV, with an 83 percent rate of success. In both groups of patients, gas exchange improved after 1 h on NIPSV, but such values were not improved on the first day in patients who failed with NIPSV.

Section snippets

Patients

All patients admitted to the ICU who experienced respiratory distress were candidates for NIPSV. Patients were selected to be ventilated with NIPSV when they seemed to clinically require endotracheal intubation and mechanical ventilation and met at least 2 of the following criteria: (1) respiration rate (RR) of 25 breaths per minute or more; (2) PaO2 below 60 mm Hg while breathing room air or below 80 mm Hg with additional oxygen; (3) PaCO2 of 50 mm Hg or more; and (4) arterial pH of 7.38 or

RESULTS

Between March 1990 and May 1990, there were 31 consecutive patients hospitalized in our ICU who met clinical and physiologic criteria indicating the need for endotracheal intubation and mechanical ventilation. Fourteen patients were excluded from the study because of the need for a surgical procedure (n = 4), multiple organ failure (n = 3), neurologic disease (n = 4), or status asthmaticus (n = 3). The remaining 17 patients were included in the study. The characteristics, diagnosis, diagnosis

DISCUSSION

Noninvasive pressure support ventilation has been recently used in patients with ARF from acute exacerbation of COPD.8, 9 In these patients, NIPSV improved gas exchange, obviated the need for endotracheal intubation, shortened the duration of ventilation and the stay in the ICU.8 On the other hand, Meduri and coworkers10 reported the findings in three patients with ARF from various causes (cardiogenic pulmonary edema; adult respiratory distress syndrome from sepsis and from Pneumocystis carinii

ACKNOWLEDGMENTS

We thank Dr. Laurent Brochard (Hôpital Henri Mondor, Creteil. France) for his technical assistance and the ICU nursing and medical staff of Hôpital International de l'Université de Paris for their cooperation.

REFERENCES (20)

There are more references available in the full text version of this article.

Cited by (0)

Manuscript received March 4; revision accepted July 16.

View full text