Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure

• Published in: Intensive care medicine Vol. 30; no. 5; pp. 875 - 881
• Main Authors: GORINI, Massimo, GINANNI, Roberta, VILLELLA, Giuseppe, TOZZI, Donatella, AUGUSTYNEN, Annike, CORRADO, Antonio
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-05-2004; Berlin Springer Nature B.V
• Subjects: Acidosis; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Blood Gas Analysis; Chronic obstructive pulmonary disease; Clinical medicine; Cohort analysis; Hospital Mortality; Hospitals; Humans; Intensive care; Intensive care medicine; Intensive Care Units; Intubation; Length of Stay; Medical sciences; Mortality; Positive-Pressure Respiration - methods; Prospective Studies; Pulmonary Disease, Chronic Obstructive - classification; Pulmonary Disease, Chronic Obstructive - therapy; Respiratory diseases; Respiratory Distress Syndrome, Adult - classification; Respiratory Distress Syndrome, Adult - therapy; Respiratory failure; Ventilators; Ventilators, Negative-Pressure; Intensive care; Respiratory disease; Negative pressure ventilation; Negative pressure; Non-invasive mechanical ventilation; Chronic; Treatment; Respiratory failure; Positive pressure; Non-invasive positive pressure ventilation; Acute respiratory failure; Chronic obstructive pulmonary disease; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-003-2145-9

To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders.
An 18 months prospective cohort study.
A specialised respiratory intensive care unit in a university-affiliated hospital.
A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders.
Criteria for starting non-invasive mechanical ventilation and for endotracheal intubation were predefined. Non-invasive mechanical ventilation was provided by positive pressure (NPPV) ventilators or iron lung (NPV).
The main characteristics of patients (70% with chronic obstructive pulmonary disease) on admission were (mean, SD or median, 25th-75th centiles): pH 7.29 (0.07), PaCO(2) 83 mm Hg (19), PaO(2)/FiO(2) 198 (77), APACHE II score 19 (15-24). Among the 258 patients, 200 (77%) were treated exclusively with non-invasive mechanical ventilation (40% with NPV, 23% with NPPV, and 14% with the sequential use of both), and 35 (14%) with invasive mechanical ventilation. In patients in whom NPV or NPPV failed, the sequential use of the alternative non-invasive ventilatory technique allowed a significant reduction in the failure of non-invasive mechanical ventilation (from 23.4 to 8.8%, p=0.002, and from 25.3 to 5%, p=0.0001, respectively). In patients as a whole, the hospital mortality (21%) was lower than that estimated by APACHE II score (28%).
Using NPV and NPPV it was possible in clinical practice to avoid endotracheal intubation in the large majority of unselected patients with acute respiratory failure on chronic respiratory disorders needing ventilatory support. The sequential use of both modalities may increase further the effectiveness of non-invasive mechanical ventilation.