Document Detail

Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure.
MedLine Citation:
PMID:  1864119     Owner:  NLM     Status:  MEDLINE    
Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a face mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in PCO2 (greater than 16 percent decrease) and in pH (from less than 7.30 to greater than 7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the face mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency.
G U Meduri; N Abou-Shala; R C Fox; C B Jones; K V Leeper; R G Wunderink
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  100     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1991 Aug 
Date Detail:
Created Date:  1991-09-06     Completed Date:  1991-09-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  445-54     Citation Subset:  AIM; IM; S    
Pulmonary, and Critical Care Division, University of Tennessee, Memphis.
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MeSH Terms
Acidosis, Respiratory / therapy
Acute Disease
Aged, 80 and over
Dyspnea / physiopathology
Hypercapnia / physiopathology,  therapy*
Intermittent Positive-Pressure Ventilation / methods
Intubation, Intratracheal
Middle Aged
Oxygen Inhalation Therapy / instrumentation,  methods
Positive-Pressure Respiration / methods
Prospective Studies
Respiration, Artificial / instrumentation,  methods*
Respiratory Insufficiency / physiopathology,  therapy*
Respiratory Mechanics / physiology
Respiratory Muscles / physiopathology
Status Asthmaticus / therapy
Comment In:
Chest. 1993 Apr;103(4):1304-5   [PMID:  8131500 ]

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