Document Detail


Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure.
MedLine Citation:
PMID:  23263582     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the impact of switching to total face mask in cases where face mask-delivered noninvasive mechanical ventilation has already failed in do-not-intubate patients in acute respiratory failure.
DESIGN AND SETTING: Prospective observational study in an ICU and a respiratory stepdown unit over a 12-month study period.
INTERVENTION: Switching to total face mask, which covers the entire face, when noninvasive mechanical ventilation using facial mask (oronasal mask) failed to reverse acute respiratory failure.
PATIENTS: Seventy-four patients with a do-not-intubate order and treated by noninvasive mechanical ventilation for acute respiratory failure.
MAIN RESULTS: Failure of face mask-delivered noninvasive mechanical ventilation was associated with a three-fold increase in in-hospital mortality (36% vs. 10.5%; p = 0.009). Nevertheless, 23 out of 36 patients (64%) in whom face mask-delivered noninvasive mechanical ventilation failed to reverse acute respiratory failure and, therefore, switched to total face mask survived hospital discharge. Reasons for switching from facial mask to total face mask included refractory hypercapnic acute respiratory failure (n = 24, 66.7%), painful skin breakdown or facial mask intolerance (n = 11, 30%), and refractory hypoxemia (n = 1, 2.7%). In the 24 patients switched from facial mask to total face mask because of refractory hypercapnia, encephalopathy score (3 [3-4] vs. 2 [2-3]; p < 0.0001), PaCO2 (87 ± 25 mm Hg vs. 70 ± 17 mm Hg; p < 0.0001), and pH (7.24 ± 0.1 vs. 7.32 ± 0.09; p < 0.0001) significantly improved after 2 hrs of total face mask-delivered noninvasive ventilation. Patients switched early to total face mask (in the first 12 hrs) developed less pressure sores (n = 5, 24% vs. n = 13, 87%; p = 0.0002), despite greater length of noninvasive mechanical ventilation within the first 48 hrs (44 hrs vs. 34 hrs; p = 0.05) and less protective dressings (n = 2, 9.5% vs. n = 8, 53.3%; p = 0.007). The optimal cutoff value for face mask-delivered noninvasive mechanical ventilation duration in predicting facial pressure sores was 11 hrs (area under the receiver operating characteristic curve, 0.86 ± 0.04; 95% confidence interval 0.76-0.93; p < 0.0001; sensitivity, 84%; specificity, 71%).
CONCLUSION: In patients in hypercapnic acute respiratory failure, for whom escalation to intubation is deemed inappropriate, switching to total face mask can be proposed as a last resort therapy when face mask-delivered noninvasive mechanical ventilation has already failed to reverse acute respiratory failure. This strategy is particularly adapted to provide prolonged periods of continuous noninvasive mechanical ventilation while preventing facial pressure sores.
Authors:
Malcolm Lemyze; Jihad Mallat; Olivier Nigeon; Stéphanie Barrailler; Florent Pepy; Gaëlle Gasan; Nicolas Vangrunderbeeck; Philippe Grosset; Laurent Tronchon; Didier Thevenin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-08     Revised Date:  2013-10-09    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  481-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France. malcolmlemyze@yahoo.fr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Anoxia / therapy
Female
Hospital Mortality
Humans
Hypercapnia / therapy
Intensive Care Units
Intubation, Intratracheal / contraindications
Length of Stay
Male
Masks* / adverse effects
Middle Aged
Noninvasive Ventilation / instrumentation*,  methods
Pressure Ulcer / etiology,  prevention & control
Prospective Studies
Respiratory Insufficiency / mortality,  therapy*
Treatment Refusal
Comments/Corrections
Comment In:
Crit Care Med. 2013 Sep;41(9):e233   [PMID:  23979383 ]
Crit Care Med. 2013 Sep;41(9):e233-4   [PMID:  23979384 ]
Crit Care Med. 2013 Feb;41(2):675   [PMID:  23353953 ]

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


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