Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.

Abstract

Results -There were 45 treatment failures (30%) and 36 deaths (24%). Nine patients (6%) required intubation because of lack of airway control. The median total duration of ventilation was 27 hours per patient (range 2-274). The 105 successfully treated cases recovered consciousness after a median of four hours (range 1-90) of continuous ventilatory treatment and were discharged after 12.1 (9.0) days. Conclusions -These results show that, in patients with acute on chronic respiratory failure and hypoxic hypercapnic coma, the iron lung resulted in a high rate ofsuccess. As this study has the typical limitations of all retrospective and uncontrolled studies, the results need to be formally confirmed by controlled prospective studies. Confirmation of these results could widen the range of application of non-invasive ventilatory techniques.

Iron lungversusconventional mechanical ventilation in acute exacerbation of COPD

“…Secondly, avoiding endotracheal intubation the patients treated with ILV are exposed to a lower risk of infectious complications, in line with data obtained using mask ventilation [3,7,19,20]. Confirming preliminary findings [8,11], this study shows that ILV avoided endotracheal intubation in 82% of patients with a similar ICU and hospital mortality rates compared with IMV. The mortality rate found in the IMV group is in line with that reported in COPD patients by SENEFF et al [21] and ESTEBAN et al [22], 32% and 28%, respectively.…”

“…Iron lung ventilation. The iron lung settings were similar to those previously reported [8,12]. Briefly, the ventilator was set to deliver peak inspiratory pressures ranging -30--40 cmH 2 O and peak expiratory pressures from 10-15 cmH 2 O. Inspiratory pressure was set in each individual patient in order to obtain a tidal volume (VT) ofy6 mL?kg -1 intermittently recorded at the mouth by means of a Wright9s ventilograph.…”

“…It has been reported that COPD patients with severe respiratory acidosis and hypercapnic coma can be successfully treated with iron lung ventilation (ILV) [8]. A case-control study [9] suggested that ILV is as effective as IMV in the treatment of COPD patients with acute on chronic respiratory failure and is associated to a shorter duration of ventilation, and a similar length of hospital stay.…”

“…Compared with standard medical therapy, noninvasive positive pressure ventilation (NIPPV) reduces the need for endotracheal intubation [3][4][5], the length of hospital stay [3], and the in-hospital mortality rate [3][4][5][6]. Recently, it was shown that in COPD patients with severe respiratory failure that failed medical therapy in the ward, NIPPV compared with invasive mechanical ventilation (IMV) resulted in a similar mortality rate, length of hospital stay and duration of mechanical ventilation [7].It has been reported that COPD patients with severe respiratory acidosis and hypercapnic coma can be successfully treated with iron lung ventilation (ILV) [8]. A case-control study [9] suggested that ILV is as effective as IMV in the treatment of COPD patients with acute on chronic respiratory failure and is associated to a shorter duration of ventilation, and a similar length of hospital stay.…”

Is there still a negative side to noninvasive ventilation?

“…The current trial [1] and the previous case-control study by the same authors [11] establish that iron lung ventilation is effective at improving gas exchange abnormalities in chronic obstructive pulmonary disease patients with severe hypercarbia. Furthermore, outcomes, such as complication and mortality rates, are within the ranges reported for noninvasive positive pressure ventilation [9,10].…”