Noninvasive Positive Pressure Ventilation In Patients Research Articles

Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients

PurposeThe objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure. Material and methodsA retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first-line therapy for hypoxemic respiratory failure. ResultsOf the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P < .0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P=.031), non-Caucasian race (OR, 1.61; 95% CI, 1.14-2.26; P=.006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33-2.64; P=.0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08-1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group. ConclusionNoninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.

Rate of oral intake and effects of mechanical insufflation-exsufflation on pulmonary complications in patients with duchenne muscular dystrophy.

[Purpose] In Duchenne muscular dystrophy, it increases risks of difficulties of expectoration of secretion, asphyxia, aspiration pneumonia because of decreased cough function. The aim of this study is to prove that manually assisted coughing or mechanical insufflation-exsufflation prevents pulmonary complication and contribute to continue oral intake safely and continue rate of oral intake in Duchenne muscular dystrophy. [Subjects and Methods] We investigated the status of using ventilator, manually assisted coughing or mechanical insufflation-exsufflation, and oral intake or not. In addition, we inspected the frequency of fever (over 37 °C) needed antibiotics from medical records for index of respiratory tract infection, and compared with every period of using mechanical insufflation-exsufflation from respiratory evaluation on cough peak flow. [Results] Fifty-eight patients participated in this study. There were 45 Full-time noninvasive positive pressure ventilation patients. Forty-three in 45 Full-time noninvasive positive pressure ventilation patients (95.6%) avoided tracheostomy and continued noninvasive positive pressure ventilation because they continued oral intake without tracheal intubation due to the respiratory acute exacerbation by asphyxia or aspiration pneumonia. [Conclusion] Duchenne muscular dystrophy patients can continue oral intake safely while preventing pulmonary complication by using manually assisted coughing or mechanical insufflation-exsufflation.

Non-invasive ventilation in acute respiratory failure: a meta-analysis

Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. We performed this meta-analysis to investigate the utility of NPPV intervention in patients with acute respiratory failure (ARF). A comprehensive literature search identified 12 studies enrolling a total of 963 patients from Medline, PubMed, Cochrane and EMBASE databases that assessed the effectiveness of NPPV versus conventional mechanical ventilation and/or non-ventilation therapy in patients with ARF, irrespective of the underlying aetiology, as well as mortality rate and the length of intensive care unit (ICU) or hospital stay. The usage of NPPV was associated with significantly decreased intubation (pooled OR=0.23, 95% CI 0.12-0.42, p<0.001) and ICU mortality rate (pooled OR=0.34, 95% CI 0.20-0.60, p<0.001), but did not influence the hospital mortality rate (pooled OR=0.77, 95% CI 0.32-1.81, p=0.543) and the length of ICU or hospital stay (ICU stay: difference in means=0.38, 95% CI -3.01 to 3.77, p=0.825; hospital stay: difference in means=2.76, 95% CI -1.74 to 7.27, p=0.229). In conclusion, usage of NPPV in patients with ARF is associated with lower intubation and in-ICU mortality rate.

Failure of noninvasive ventilation in adult patients with acute asthma exacerbation.

Failure of noninvasive ventilation in adult patients with acute asthma exacerbation.

Delirium during Noninvasive Positive Pressure Ventilation: A Prospective Observational Study

Background: Noninvasive positive pressure ventilation (NPPV) has been used to treat acute respiratory failure in intensive care units (ICU), while some patients need tracheal intubation because of not only underlying diseases but also delirium. Delirium in patients being mechanically ventilated via endotracheal tubes has been subject to concern and investigated in numerous studies, however in patients receiving NPPV has been little studied. The aim of the study was to discover the incidence of delirium in NPPV patients. Methods: Adult patients who received NPPV were enrolled. Basic profiles of patients, underlying diseases, indication of NPPV, duration of NPPV, length of stay in ICU, NPPV settings, administration of sedative agents and outcome were collected. Delirium was diagnosed with the Confusion Assessment Method for the ICU (CAM-ICU) by attending nurses. Results: Forty-three adult patients who received NPPV were enrolled. For all patients, NPPV was applied via full face mask. The diagnosis of 30 patients (69%) was cardiogenic pulmonary edema. Delirium was observed in 16 patients (37%). Patients with delirium were older than those without (78.4 vs. 69.5 years old, p = 0.031). Thirty-one patients (72%) were successfully weaned from NPPV. NPPV failure rate was 38% for patients with delirium and 22% for patients without (p = 0.313). Dexmedetomidine was administered to 26 (61%) patients during NPPV. A few studies reported the incidence of delirium during NPPV for hypercapnic respiratory failure. We found an incidence of delirium similar to patients with hypercapnic respiratory failure. Dexmedetomidine was most frequently administered because it carried minimal risk of respiratory depression, while we are unable to unconditionally rely on the safety of dexmedetomidine during NPPV. Conclusions: The incidence of delirium in patients who received NPPV for normocapnic respiratory failure was as high as NPPV for hypercapnic patients. While it was lower than for patients receiving invasive mechanical ventilation.

Cadaveric validation of porcine model suggests noninvasive positive pressure ventilation may be safe following esophagectomy.

We previously used a pig model to demonstrate that noninvasive positive pressure ventilation (NPPV) may be a safe alternative to endotracheal intubation (ET). We sought to validate our model by quantifying the pressure threshold of esophageal anastomoses in human cadavers as a step before a clinical trial. We performed stapled side-to-side, functional end-to-end esophageal anastomoses in 10 cadaveric specimens from autopsy. With intraluminal pressure monitoring, we insufflated the anastomosis with air until a leak was observed, and measured the maximum tolerated pressure. Cadaveric esophageal anastomoses tolerated 101±39 cmH2O (range, 63-140 cmH2O) of pressure before leak was observed. The maximum pressure threshold ranged from 59 to 246 cmH2O. The leak was always at the anastomosis. There was no significant difference in pressure threshold between cadaveric and previously described porcine anastomoses. We created a human cadaveric model that in conjunction with our porcine data demonstrates that a human esophageal anastomosis can tolerate manifold higher pressures than are delivered to the esophagus by NPPV. This is the final step before a trial of NPPV in patients following esophagectomy.

The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease

The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease Myoung kyu Lee, Sang-ha Kim, Suk joong Yong, Kye chul Shin, Jiwon Choi, Yeun seoung Choi, Ye-ryung Jung, Seok jeong Lee, Won-yeon Lee Yonsei University Wonju College of Medicine, Republic of Korea Background/Purpose: Although high-flow nasal cannula (HFNC) oxygen therapy has been used gradually as a method of respiratory support, its evidence is still lacking. Noninvasive positive pressure ventilation (NIPPV) has been used in chronic obstructive pulmonary disease (COPD) patients, especially with severe acute exacerbation of COPD (AECOPD). The purpose of this study is to investigate and compare the prognosis of severe AECOPD patients who were treated with HFNC therapy and NIPPV. Methods: We conducted a prospective randomized controlled trial to compare HFNC therapy with NIPPV for patients (≥40 years old) with severe AECOPD in a tertiary referral hospital. Seventy-two patients with severe AECOPD having mild to moderate respiratory failure were enrolled in this prospective study. We evaluated 30-day mortality and the duration switching from 2 devices to conventional oxygen therapy. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and mortality rate was 16.6%. Forty-two patients (72.0 ± 9.1) were managed with HFNC oxygen therapy, and 30 patients (73.1 ± 10.4), with NIPPV. Thirty-day mortality was 14.0% and 19.0% (P = .313) in each treatment group, and the duration switching from 2 devices to conventional oxygen therapy was 7.1 ± 6.6 and 6.4 ± 7.8 days (P= .105), respectively. Conclusions: In severe AECOPD patients with mild to moderate respiratory failure, HFNC oxygen therapy compared to NIPPV did not show a statistical difference in 30-day mortality and the duration until the AECOPD gets improved. We expect that HFNC can be used as substitute in severe AECOPD patient requiring NIPPV; however, more prospective and multicenter studies should be required.

Fluoride levels with long-term volatile sedation within the intensive care unit

The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease Myoung kyu Lee, Sang-ha Kim, Suk joong Yong, Kye chul Shin, Jiwon Choi, Yeun seoung Choi, Ye-ryung Jung, Seok jeong Lee, Won-yeon Lee Yonsei University Wonju College of Medicine, Republic of Korea Background/Purpose: Although high-flow nasal cannula (HFNC) oxygen therapy has been used gradually as a method of respiratory support, its evidence is still lacking. Noninvasive positive pressure ventilation (NIPPV) has been used in chronic obstructive pulmonary disease (COPD) patients, especially with severe acute exacerbation of COPD (AECOPD). The purpose of this study is to investigate and compare the prognosis of severe AECOPD patients who were treated with HFNC therapy and NIPPV. Methods: We conducted a prospective randomized controlled trial to compare HFNC therapy with NIPPV for patients (≥40 years old) with severe AECOPD in a tertiary referral hospital. Seventy-two patients with severe AECOPD having mild to moderate respiratory failure were enrolled in this prospective study. We evaluated 30-day mortality and the duration switching from 2 devices to conventional oxygen therapy. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and mortality rate was 16.6%. Forty-two patients (72.0 ± 9.1) were managed with HFNC oxygen therapy, and 30 patients (73.1 ± 10.4), with NIPPV. Thirty-day mortality was 14.0% and 19.0% (P = .313) in each treatment group, and the duration switching from 2 devices to conventional oxygen therapy was 7.1 ± 6.6 and 6.4 ± 7.8 days (P= .105), respectively. Conclusions: In severe AECOPD patients with mild to moderate respiratory failure, HFNC oxygen therapy compared to NIPPV did not show a statistical difference in 30-day mortality and the duration until the AECOPD gets improved. We expect that HFNC can be used as substitute in severe AECOPD patient requiring NIPPV; however, more prospective and multicenter studies should be required.

Bi-level positive airway pressure ventilation for patients with stable hypercapnic chronic obstructive pulmonary disease

BackgroundThe role of noninvasive positive pressure ventilation (NPPV) has been well established in the treatment of acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD), however, its benefits in clinically stable hypercapnic COPD patients still not well known, so this trial aimed to assess the efficacy of NPPV in patients with stable hypercapnic COPD. Patients and methodsThis study included 30 stable hypercapnic COPD patients hospitalized for long term stay from June 2012 to May 2014. The 30 patients who met the study criteria were randomized into the control group (15 patients: 13 males and 2 females with mean age 66±6.2) maintained on standard treatment and the second group (15 patients: 12 males and 3 females with mean age 65±7.3) received bi-level positive pressure ventilation added to their standard treatment after giving a written consent. The patients were evaluated and followed up after initiating this therapy. ResultsAfter 6months of NPPV, daytime PaCO2 (mmHg) during spontaneous breathing decreased from 55.2±6.7 to 47.1±3.1mmHg and daytime PaO2 (mmHg) on room air increased from 48±6.1 to 55.1±8.3 with improvement of dyspnea scale and quality of life parameters. This was achieved with mean inspiratory pressures of 19.7±2.41cm H2O and mean expiratory pressures of 6.8±1.7cm H2O. ConclusionsNPPV is well tolerated and can improve blood gas levels, dyspnea and quality of life parameters in patients with stable hypercapnic COPD.

Semiquantitative cough strength score and associated outcomes in noninvasive positive pressure ventilation patients with acute exacerbation of chronic obstructive pulmonary disease

Weak cough may result in the failure of noninvasive positive pressure ventilation (NPPV) in patients with AECOPD. However, no detailed descriptions have yet been published for the measurement of cough strength and associated outcomes in AECOPD patients. This study prospectively enrolled 261 AECOPD patients who received NPPV. Semiquantitative cough strength score (SCSS, ranging from 0 = weak to 5 = strong) was recorded before NPPV. Patients who required intubation were defined as NPPV failures. NPPV failed in 55 patients (21.1%). Weak cough (SCSS ≤3, OR = 8.1), high disease severity (APACHE II score >19, OR = 3.8), and malnutrition (total proteins ≤58 g/L, OR = 2.8) were independent risk factors for NPPV failure. Patients with 1, 2, and 3 risk factors were 4.7, 13.6, and 21.6 times more likely, respectively, to experience NPPV failure compared with patients with no risk factors. The NPPV failure rates were 80%, 40%, and 10.2% in patients with SCSS of 0–1, 2–3, and 4–5, respectively (p < 0.001). Compared with NPPV success patients, NPPV failure patients stayed longer in ICU (10.1 ± 7.9 days vs. 6.5 ± 4.6 days, p < 0.001), and they had higher ICU costs (€2986 ± 1906 vs. €5680 ± 3,604, p < 0.001), higher hospital costs (€ 6714 ± 7025 vs. €10,399 ± 9,509, p = 0.009), and higher hospital mortality (72.7% vs. 4.4%, p < 0.001). Moderate accuracy to distinguish NPPV failure by APACHE II score, SCSS, and total proteins was evidenced by ROC curves, with areas under the curve of 0.71, 0.78, and 0.67, respectively. A combination of all three factors reached good accuracy, with an area under the curve of 0.86. AECOPD patients with weak cough had a high risk of NPPV failure. SCSS, APACHE II scores, and total proteins were predictors of NPPV failure. Combined, these factors increased the power to predict NPPV failure.

Nutritional Risk Screening 2002 (NRS 2002) as a predictor of outcome during ward based non-invasive ventilation in COPD with respiratory failure

Objective To determine whether Nutritional Risk Screening 2002 (NRS2002) of admission independently predicts outcome of non-invasive positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients during hypercapnic respiratory failure.Methods Patients with COPD presenting with hypercapnic respiratory failure at Sichuan University Hospital between December 2010 and May 2012 and receiving NIPPV were studied prospectively.NRS2002 was measured before NIV administration.233 patients met the inclusion criteria,with NIPPV failed in 71 cases and succeed in 162 cases.The patients were followed up till they were discharged.Results After multivariate Logistic regression,the items such as baseline PaCO2,NRS2002 score could predicted 76.4％ of the failure outcome.The area under the curve was 0.767.The positive predictive value was 35.23％.The negative predictive value was 84.21％.Conclusions We can predict the risk failure of NIPPV in patients with COPD and hypercapnic respiratory failure with NRS2002 score and baseline PaCO2,and adjust the treatment project according to the evaluation result.NRS2002 supply non-invasive and portable method for predicting the failure of NIPPV. Key words: Chronic obstructive pulmonary disease; Non-invasive positive pressure ventilation; Nutrition screening; Clinical markers

Overview of reviews: mechanical interventions for the treatment and management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by a progressive and non-reversible airflow limitation and symptoms of breathlessness, sputum production and cough. COPD is the fourth most common cause of mortality worldwide and represents a significant social and economic burden. As such, effective strategies that might be employed to treat COPD and manage symptoms need to be investigated. This overview aimed to summarize the existing evidence available in the Cochrane Library regarding the use of mechanical interventions used for the treatment and management of COPD. Systematic reviews that included adult participants with diagnosed COPD who received a mechanical intervention were included. Five reviews were included, and due to the heterogeneity of these reviews, direct and indirect comparisons of the effects of the intervention were not possible. Instead, data of the effectiveness of each intervention were extracted and summarized in tables and discussed as a narrative summary. Interventions included non-invasive positive pressure ventilation (NPPV), positive airway pressure (PEP) devices and neuromuscular electrical stimulation (NMES). Evidence regarding the effectiveness of NPPV was limited, and available data do not support the use of NPPV for patients with stable COPD. NPPV might, however, be of benefit as a weaning strategy for intubated patients and for patients experiencing respiratory failure; however, more research is required. Although PEP devices are considered as a safe airway clearance technique, data do not reveal a clear clinical benefit to their use. NMES is also regarded as safe for patients with COPD, and might also be beneficial in improving exercise tolerance and improving quality of life for patients with COPD.

Randomized Controlled Trial of Noninvasive Positive Pressure Ventilation (NPPV) Versus Servoventilation in Patients with CPAP-Induced Central Sleep Apnea (Complex Sleep Apnea)

To compare the treatment effect of noninvasive positive pressure ventilation (NPPV) and anticyclic servoventilation in patients with continuous positive airway pressure (CPAP)-induced central sleep apnea (complex sleep apnea). Randomized controlled trial. Sleep center. Thirty patients who developed complex sleep apnea syndrome (CompSAS) during CPAP treatment. NPPV or servoventilation. Patients were randomized to NPPV or servo-ventilation. Full polysomnography (PSG) was performed after 6 weeks. On CPAP prior to randomization, patients in the NPPV and servoventilator arm had comparable apnea-hypopnea indices (AHI, 28.6 ± 6.5 versus 27.7 ± 9.7 events/h (mean ± standard deviation [SD])), apnea indices (AI,19 ± 5.6 versus 21.1 ± 8.6 events/h), central apnea indices (CAI, 16.7 ± 5.4 versus 18.2 ± 7.1 events/h), oxygen desaturation indices (ODI,17.5 ± 13.1 versus 24.3 ± 11.9 events/h). During initial titration NPPV and servoventilation significantly improved the AHI (9.1 ± 4.3 versus 9 ± 6.4 events/h), AI (2 ± 3.1 versus 3.5 ± 4.5 events/h) CAI (2 ± 3.1 versus 2.5 ± 3.9 events/h) and ODI (10.1 ± 4.5 versus 8.9 ± 8.4 events/h) when compared to CPAP treatment (all P < 0.05). After 6 weeks we observed the following differences: AHI (16.5 ± 8 versus 7.4 ± 4.2 events/h, P = 0.027), AI (10.4 ± 5.9 versus 1.7 ± 1.9 events/h, P = 0.001), CAI (10.2 ± 5.1 versus 1.5 ± 1.7 events/h, P < 0.0001)) and ODI (21.1 ± 9.2 versus 4.8 ± 3.4 events/h, P < 0.0001) for NPPV and servoventilation, respectively. Other sleep parameters were unaffected by any form of treatment. After 6 weeks, servoventilation treated respiratory events more effectively than NPPV in patients with complex sleep apnea syndrome.

Role of bronchoscopy during non-invasive ventilation in hypercapnic respiratory failure

Non-invasive positive-pressure ventilation (NIPPV) is the first-line treatment for hypercapnic acute respiratory failure (ARF) secondary to COPD exacerbation in selected patients. Limited data exist supporting the use of fiberoptic bronchoscopy (FOB) during this clinical setting. The aim of this study is to assess the role of FOB during NIPPV in patients with decompensated COPD acute exacerbation.

Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

Asthma is a chronic respiratory condition causing inflammation and changes to the airways. Care of people with asthma includes routine and urgent management across primary and tertiary care; however, due to sub-optimal long-term care and delays in obtaining help during acute exacerbations, the mortality and morbidity related to asthma is still a major health concern. There is reason to believe that non-invasive positive pressure ventilation (NPPV) could be beneficial to patients with severe acute asthma; however, the evidence surrounding the efficacy of NPPV is unclear, despite its common use in clinical practice. To determine the efficacy of NPPV in adults with severe acute asthma in comparison to usual medical care with respect to mortality, tracheal intubation, changes in blood gases and hospital length of stay. We carried out a search in the Cochrane Airways Group Specialised Register of trials (July 2012). Following this, the bibliographies of included studies and review articles were searched for additional studies (July 2012). We included randomised controlled trials of adults with severe acute asthma as the primary reason for presentation to the emergency department or for admission to hospital. Asthma diagnosis was defined by internationally accepted criteria. Studies were included if the intervention was usual medical care for the management of severe acute asthma plus NPPV applied through a nasal or facemask compared to usual medical care alone. Studies including patients with features of chronic obstructive pulmonary disease (COPD) were excluded unless data were provided separately for patients with asthma in studies recruiting both COPD and asthmatic patients. A combination of two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information where required. All data were analysed using RevMan 5.1. For continuous variables, a mean difference and 95% confidence interval were used and for dichotomous variables, risk ratio with 95% confidence interval were calculated. We identified six trials for inclusion. Five studies on 206 participants contributed data, while one study was available in abstract form only and was not fully incorporated into this review. For the primary outcome of endotracheal intubation there were two studies that contributed data: two intubations were needed in 45 participants on NPPV and no intubations in 41 control patients (risk ratio 4.48; 95% CI 0.23 to 89.13). There were no deaths in either of these studies. Length of hospital stay was reported in two studies, though meta-analysis was not possible. Hospitalisation was reported in one small study, in which there were three admissions out of 17 on NPPV and 10 admissions out of 16 in control patients (RR 0.28, 95% CI 0.09, 0.84). This review of studies has highlighted the paucity of data that exist to support the use of NPPV in patients in status asthmaticus. As such this course of treatment remains controversial despite its continued use in current clinical practice. Larger, prospective randomised controlled trials of rigorous methodological design are needed to determine the role of NPPV in patients with asthma.

Noninvasive positive pressure ventilation for acute respiratory failure: What role is there for patients declining intubation or choosing palliation?

Noninvasive positive pressure ventilation (NPPV) is a type of mechanical ventilation that does not require an artificial airway. The best results (decreased need for endotrcheal intubation and decreased mortality) have been reported among patients with exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema. Although NPPV is a widely accepted treatment for some patients with acute respiratory failure, the use of NPPV in patients who have decided to forego endotracheal intubation is controversial. NPPV as a palliative measure when patients and families have chosen to forego all life support, receiving comfort measures only, may also be considered as a management option in very selected patients. In any of these settings, NPPV should be applied only after careful discussion of the goals of care, with explicit parameters for success and failure, by experienced personnel, and in appropriate healthcare settings. In an era of patient-centered care, we have very little guidance in the literature from patients and families regarding their perspectives on the use of technologies such as NPPV. Future studies need to examine the perspectives of patients and families on the use of NPPV within these contexts. In the interim, the onus is on the clinician to engage the patient (where possible) and family members in a thorough discussion to clarify their goals of care near the end-of-life prior to embarking on NPPV.

Efficacy of Noninvasive Positive Pressure Ventilation in Elderly Patients with Acute Hypercapnic Respiratory Failure

Background: There have been no reports on the efficacy of noninvasive positive pressure ventilation (NPPV) in elderly patients. Objectives: The purpose of this study was to clarify the efficacy and identify the predictors of a successful outcome of NPPV in patients over the age of 75 years with acute hypercapnic respiratory failure (AHRF). Methods: We retrospectively evaluated the data of 42 patients (21 men) with AHRF who were treated at our unit. The patients were divided into survivor and nonsurvivor groups, and the clinical parameters measured prior to the initiation of NPPV were compared between the 2 groups. Results: The mean age of the patients was 83.0 ± 6.3 years. The etiology of the respiratory failure was acute exacerbation of chronic obstructive pulmonary disease in 19 patients, acute cardiogenic pulmonary edema in 18 patients, idiopathic pulmonary fibrosis in 3 patients, sequelae of tuberculosis in 1 patient, and asthma in 1 patient. Of the 42 patients, 33 (78.6%) survived. All patients with a Glasgow Coma Scale (GCS) score ≥9 and/or an APACHE II score <29 survived after the initiation of NPPV. Conclusion: An APACHE II score <29 and a GCS score ≥9 were predictors of a successful outcome of NPPV in elderly people.

Comparison of Noninvasive Ventilation by Sequential Use of Mask and Helmet versus Mask in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Preliminary Study

Background:Noninvasive positive pressure ventilation (NPPV) using a face mask is the ventilatory mode of choice in selected patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD). A high incidence of intolerance limits the use of this approach. Objective: To evaluate the sequential use of mask and helmet during NPPV in patients with severe exacerbation of COPD in order to reduce the intolerance to these devices. Methods: Fifty-three patients ventilated for the first 2 h with NPPV by mask were studied. If gas exchange and clinical status improved, they were randomized to continue on NPPV by mask or helmet.Physiological parameters were measured at admission, after the first 2 h on NPPV by mask, 4 h after randomization and at discharge. Need for intubation, ventilatory assistance, length of stay (LOS) and complications were recorded. Results: After the first 2 h of NPPV, gas exchange and clinical parameters improved in 40 patients. Four hours after randomization, PaCO₂ was lower in the mask group than in the helmet group. Nine patients in the mask group and 2 in the helmet group failed NPPV, 8 and 1, respectively, owing to intolerance. Time of noninvasive ventilation and LOS were lower in the mask than in the helmet group. Conclusions: In patients with acute exacerbation of COPD and undergoing NPPV, the sequential use of a mask and helmet diminished the incidence of failure. Under the present experimental conditions, the use of a helmet increased LOS and the duration of artificial ventilation.

Application of noninvasive positive pressure ventilation in patients with severe respiratory acidosis due to acute exacerbation of COPD

Objective To compare the effect of noninvasive positive pressure ventilation (NPPV) in severely respiratory acidotic with mildly respiratory acidotic patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Methods Comparison of NPPV in enrolled patients with acute exacerbation of COPD with mild(pH 7.25 ～ 7.35) or severe(pH＜7.25) respiratory acidosis on changes of pH and PaCO2 after 2 h of NPPV, ratio of patients to normalise pH after 24h of NPPV, duration of NIV treatment, length of stay in hospital. Results 44 with mild(pH 7.25 ～ 7.35) respiratory acidosis and 42 severe(pH＜7.25) respiratory acidosis. Compared with the mildly acidotic group, the severely acidotic group took a similar improvements for pH (0.04 ± 0.01)vs (0.06 ± 0.03) respectively, P=0.41 and PaCO2 (14.3 ± 7.4) vs (18.1 ± 11.2) mmHg respectively,P=0.34 )after 2 h of N PPV, with similar ratio of patients to normalise pH after 24h of NPPV ( 65.9% and 59.5% respectively,P=0.65), with similar duration of N PPV treatment (103 ± 8.1) vs (106 ± 6.6)h, respectively, (P=0.74) and hospital length of stay (13 ± 2.7) vs (15 ± 4.1)days, respectively, P=0.53. Conclusion NPPV is effective in the treatment of patients with severe respiratory acidosis due to acute exacerbation of COPD. Key words: Noninvasive positive pressure ventilation(NPPV); Chronic obstructive pulmonary disease(COPD); Acute exacerbation of chronic obstructive lung disease; Respiratory acidosis

S68 Evaluation of non-invasive ventilation in management of acute severe asthma

ObjectivesTo study the role of non-invasive positive pressure ventilation (NIPPV) in management of acute severe asthma.Study designOpen randomised controlled trial.Methods50 patients of acute severe asthma having asthma for at least...