Document Detail

Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema (ACPE)
MedLine Citation:
PMID:  10051074     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To assess (1) the short-term hemodynamic, respiratory and arterial blood gas effects of NIPSV in patients with ACPE who were likely to require endotracheal intubation, (2) the initial causes of failure and (3) the side effects and the difficulties of this technique.
DESIGN: Uncontrolled, prospective clinical study.
SETTING: Teaching hospital intensive care unit.
PATIENTS: 26 consecutive patients with severe ACPE.
INTERVENTIONS: Noninvasive ventilation via a face mask, using a pressure support mode (20.5+/-4.7 cm H2O), with an initial fractional inspired oxygen of 93.0+/-16% and a positive end-expiratory pressure of 3.5+/-2.3 cm H2O. The need to intubate the patients within 48 h was considered as a criterion of failure of the procedure.
MEASUREMENTS AND RESULTS: Clinical and biological parameters were measured at 15 and 30 minutes, 1 h and 2 h and at 1 h and 2 h, respectively. There were 5 (21%) failures and 21 (79%) successes. In both the success and the failure groups, clinical and blood gas parameters improved at the first measure. In the success group, within 15 min of the start of NIPSV, pulse oximetry saturation (SpO2) had increased from 84+/-12 to 96+/-4% (p<0.001), the respiratory rate (RR) had decreased from 36+/-5.3 to 22.4+/-4.9 breaths/ min (p<0.0001) and within 1 h the arterial oxygen tension and pH, respectively, had increased from 61+/-14 to 270+/-126 mm Hg (p<0.0001) and from 7.25+/-0.11 to 7.34+/-0.07 (p<0.01) and the arterial carbon dioxide tension (PaCO2) had decreased from 54.2+/-15 to 43.4+/-6.4 mm Hg (p<0.01). There were no statistical differences between the success and failure groups for the initial clinical parameters: SpO2, RR, heart rate, mean arterial pressure. The only differences between the success and failure groups were in the PaCO2 (54.2+/-15 vs. 32+/-2.1 mm Hg, p<0.001) and the creatine kinase (CPK) (176+/-149 vs. 1282+/-2080 IU/l, p<0.05); this difference in CPK activity was related to the number of patients who had an acute myocardial infarction (AMI) (4/5 in the failure group vs. 2/21 in the success group, p<0.05). All patients with AMI in the failure group died.
CONCLUSION: Among patients in acute respiratory failure, those with severe ACPE could benefit from NIPSV if they are hypercapnic, but NIPSV should be avoided in those with AMI.
T Rusterholtz; J Kempf; C Berton; S Gayol; C Tournoud; M Zaehringer; A Jaeger; P Sauder
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  25     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  21-8     Citation Subset:  IM    
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MeSH Terms
Acute Disease
Aged, 80 and over
Blood Gas Analysis
Heart Diseases / complications*,  physiopathology
Middle Aged
Positive-Pressure Respiration* / methods
Prospective Studies
Pulmonary Edema / etiology*,  physiopathology,  therapy
Pulmonary Ventilation*
Respiratory Distress Syndrome, Adult / etiology*,  physiopathology,  therapy
Treatment Outcome
Comment In:
Intensive Care Med. 1999 Jan;25(1):1-2   [PMID:  10051070 ]

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

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