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Minerva Anestesiologica 2001 March;67(3):107-15

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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