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Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure. 2004

Massimo Gorini, and Roberta Ginanni, and Giuseppe Villella, and Donatella Tozzi, and Annike Augustynen, and Antonio Corrado
Respiratory Intensive Care Unit, Careggi Hospital CTO, Largo Palagi 1, 50134 Florence, Italy. massimogorini@libero.it

OBJECTIVE To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders. METHODS An 18 months prospective cohort study. METHODS A specialised respiratory intensive care unit in a university-affiliated hospital. METHODS A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders. METHODS 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.

UI MeSH Term Description Entries
D007362 Intensive Care Units Hospital units providing continuous surveillance and care to acutely ill patients. ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D012128 Respiratory Distress Syndrome A syndrome characterized by progressive life-threatening RESPIRATORY INSUFFICIENCY in the absence of known LUNG DISEASES, usually following a systemic insult such as surgery or major TRAUMA. ARDS, Human,Acute Respiratory Distress Syndrome,Adult Respiratory Distress Syndrome,Pediatric Respiratory Distress Syndrome,Respiratory Distress Syndrome, Acute,Respiratory Distress Syndrome, Adult,Respiratory Distress Syndrome, Pediatric,Shock Lung,Distress Syndrome, Respiratory,Distress Syndromes, Respiratory,Human ARDS,Lung, Shock,Respiratory Distress Syndromes,Syndrome, Respiratory Distress
D001784 Blood Gas Analysis Measurement of oxygen and carbon dioxide in the blood. Analysis, Blood Gas,Analyses, Blood Gas,Blood Gas Analyses,Gas Analyses, Blood,Gas Analysis, Blood
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D015919 Ventilators, Negative-Pressure Body ventilators that assist ventilation by applying intermittent subatmospheric pressure around the thorax, abdomen, or airway and periodically expand the chest wall and inflate the lungs. They are relatively simple to operate and do not require tracheostomy. These devices include the tank ventilators ("iron lung"), Portalung, Pneumowrap, and chest cuirass ("tortoise shell"). Negative-Pressure Ventilators,Respirators, Negative-Pressure,Respirators, Pulmonary, Negative-Pressure,Ventilators, Pulmonary, Negative-Pressure,Negative-Pressure Pulmonary Ventilator,Negative-Pressure Pulmonary Ventilators,Pulmonary Ventilator, Negative-Pressure,Pulmonary Ventilators, Negative-Pressure,Tank Ventilators,Ventilator, Negative-Pressure Pulmonary,Negative Pressure Pulmonary Ventilator,Negative Pressure Pulmonary Ventilators,Negative Pressure Ventilators,Negative-Pressure Respirator,Negative-Pressure Respirators,Negative-Pressure Ventilator,Pulmonary Ventilator, Negative Pressure,Pulmonary Ventilators, Negative Pressure,Respirator, Negative-Pressure,Respirators, Negative Pressure,Tank Ventilator,Ventilator, Negative Pressure Pulmonary,Ventilator, Negative-Pressure,Ventilator, Tank,Ventilators, Negative Pressure,Ventilators, Negative-Pressure Pulmonary,Ventilators, Tank
D017052 Hospital Mortality A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. In-Hospital Mortality,Mortality, Hospital,Hospital Mortalities,In Hospital Mortalities,In Hospital Mortality,Inhospital Mortalities,Inhospital Mortality,Mortalities, In-house,Mortalities, Inhospital,Mortality, In-Hospital,Mortality, Inhospital,Hospital Mortalities, In,Hospital Mortality, In,In-Hospital Mortalities,In-house Mortalities,In-house Mortality,Mortalities, Hospital,Mortalities, In Hospital,Mortalities, In house,Mortalities, In-Hospital,Mortality, In Hospital,Mortality, In-house

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