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Online ISSN 1827-1596
CRITICAL AND INTENSIVE THERAPY
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.