Document Detail


Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure.
MedLine Citation:
PMID:  14735237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders. DESIGN: An 18 months prospective cohort study. SETTING: A specialised respiratory intensive care unit in a university-affiliated hospital. PATIENTS: A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders. INTERVENTIONS: 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). RESULTS: 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%). CONCLUSIONS: 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.
Authors:
Massimo Gorini; Roberta Ginanni; Giuseppe Villella; Donatella Tozzi; Annike Augustynen; Antonio Corrado
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Publication Detail:
Type:  Journal Article     Date:  2004-01-21
Journal Detail:
Title:  Intensive care medicine     Volume:  30     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-05     Completed Date:  2004-09-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  875-81     Citation Subset:  IM    
Affiliation:
Respiratory Intensive Care Unit, Careggi Hospital CTO, Largo Palagi 1, 50134 Florence, Italy. massimogorini@libero.it
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Blood Gas Analysis
Hospital Mortality*
Humans
Intensive Care Units
Length of Stay
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Disease, Chronic Obstructive / classification,  therapy*
Respiratory Distress Syndrome, Adult / classification,  therapy*
Ventilators, Negative-Pressure*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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