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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES CRITICAL AND INTENSIVE THERAPY
Minerva Anestesiologica 2001 March;67(3):107-15
Non-invasive pressure support ventilation in acute hypoxemic (non hypercapnic) respiratory failure. Observations in Respiratory Intermediate Intensive Care Unit
Mollica C., Brunetti G., Buscajoni M., Cecchini L., Maialetti E., Marazzi M., Principe R., Sabato R., Antonini V. E.
From the Azienda Ospedaliera «S. Camillo - Forlanini» STIRS - Roma
Background. Non-invasive positive pressure support ventilation (NIPSV).
Methods. In patients with acute hypoxaemic (PaO2/FiO2 ≤100) non hypercapnic respiratory failure (ARF) admitted to a Respiratory Inter-mediate Intensive Care Unit of a general Hospital, between January 1993 and December 1997.
Results. In 21 selected patients (PaO2/ FiO2T0=82±9) NIPSV improved PaO2 in 13/21 patients (Group A) and did not improve in 8/21 patients (Group B) (PaO2/FiO2T1=154±25 in Group A vs PaO2/FiO2T1=106±7.5 in Group B, p=0.00001). Upon admission the two groups did neither significantly differ for blood gas values (PaO2/FiO2T0=84±9.6 in Group A vs 79.8±8.7 in Group B), nor for clinical status (APACHE II=19.8±5 in Group A vs 24.6±7 in Group B). Shorter duration of NIPSV in Group B patients (11.2±19.7 hrs vs 35.3±32.3 hrs in Group A, p=0.047), in spite of a rise in PEEP (9.3±2.3 in Group B vs 5.5±2.4 in Group A, p=0.003) and Pressure Support (18.7±1.8 in Group B vs 15±3.2 in Group A, p=0.004) was due to onset of conditions which required shifting from NIPSV to endotracheal intubation (ETI). Outcome: 8/21 patients were successfully treated by only NIPSV. 8/21 patients were intubated. 5/21 patients dead in RIICU; 1 month survival: 9/21 patients. Side effects: mask intolerance (3/21); skin necrosis (1/21); pneumothorax (1/21).
Conclusions. NIPSV may be tried in ARF patients to improve PaO2 and avoid ETI.