Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients

Fernández, Rafael; Blanch, L.; Vallès, Jordi; Baigorri, F.; Artigas, A.

doi:10.1007/bf01711087

Cited by 80 publications

(32 citation statements)

References 29 publications

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“…However, since the institution of the rescue protocol resulted in the avoidance of actual intubation in seven out of 10 patients, and since it is actual intubation (and its complications) which explain the differences in outcomes previously demonstrated between intubation and active NPPV, it follows that no such difference was to be expected in this study. The total failure rate of active NPPV in the present study was 15%, a figure in the range of the published studies in patients with a similar degree of severity (table 5) [7,10,12,13,15,16,19,[30][31][32][33][34][35]. The fact that the attending physician was not blinded to the active or placebo nature of the treatment under study could have influenced the results.…”

Section: Discussionsupporting

confidence: 52%

Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial

Thys

Roeseler²,

Reynaert³

et al. 2002

European Respiratory Journal

100

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The aim of the present study was to clarify whether the known effects of noninvasive positive-pressure ventilation (NPPV) in patients with respiratory failure are real or due to placebo effects and whether early application of NPPV in the emergency department leads to rapid improvement of the patients condition and outcome.A prospective randomised placebo-controlled study was conducted in 20 patients with severe acute respiratory failure (ARF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute pulmonary oedema, not improving under conventional medical therapy and on the edge of intubation. Patients received either conventional medical therapy plus two-level NPPV (bi-level NPPV) or conventional medical therapy plus "placebo" NPPV.The main outcome measures involved the need for endotracheal intubation in the bilevel NPPV arm and in the placebo arm after crossing over to active NPPV. Morbidity, length of stay, mortality and the effect of the ventilatory mode on clinical, arterialblood gas parameters, and the sternocleidomastoid muscles electromyogram (EMG) activity were also measured.The 10 patients in the active NPPV group rapidly improved and none needed intubation. Placebo NPPV resulted in no change in the clinical condition of patients that continued to worsen and the 10 patients were crossed over to active NPPV. Three patients were intubated. No differences in terms of morbidity, length of stay or mortality between the two groups were observed. Active NPPV (but not placebo NPPV) led to a rapid and significant improvement in the clinical parameters, pH and the carbon dioxide tension in arterial blood and to a decrease in respiratory frequency and sternocleidomastoid EMG activity. Early application of bi-level noninvasive positive-pressure ventilation in patients with severe acute respiratory failure, due to chronic obstructive pulmonary disease and acute pulmonary oedema, leads to a rapid improvement in clinical status and blood gases. Noninvasive positive-pressure ventilation had no placebo effect. Eur Respir J 2002; 20: 545-555.

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Section: Discussionsupporting

confidence: 52%

Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial

Thys

Roeseler²,

Reynaert³

et al. 2002

European Respiratory Journal

100

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“…Thus, in the study by FERNANDEZ et al [24], NIPSV was performed for a period of only 8±4 h. In the first 24 h of the present protocol, the mean number of hours of mask ventilation·day -1 for each patient was 7±4. Finally, these durations of ventilation on the first day of the protocol are close to those noted in other studies [1,4,24], whilst offering a harmonious distribution of ventilation sessions. In our experience [13, 25, present study] NIPSV with a sequential utilization is well tolerated by patients and allows use of the technique for several days until the patient's condition improves.…”

Section: Discussionmentioning

confidence: 71%

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Hilbert¹,

Gruson²,

Portel³

et al. 1998

Eur Respir J

199

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Patients with chronic obstructive pulmonary disease (COPD) who have been intubated and mechanically ventilated may prove difficult to wean. Noninvasive ventilation may be used in an attempt to avoid new endotracheal intubation. The efficacy of administration of noninvasive pressure support ventilation was evaluated in 30 COPD patients with postextubation hypercapnic respiratory insufficiency, compared with 30 historically matched control patients who were treated conventionally. Patients were included in the study if, within 72 h postextubation, they presented with respiratory distress, defined as the combination of a respiratory frequency >25 breaths x min(-1), an increase in the arterial carbon dioxide tension (Pa,CO2) of at least 20% compared with the value measured after extubation, and a pH <7.35. Noninvasive pressure support ventilation was effective in correcting gas exchange abnormalities. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation: 20 of the 30 patients (67%) in the control group required endotracheal intubation, compared with only six of the 30 patients (20%) in the noninvasive-ventilation group (p<0.001). In-hospital mortality was not significantly different between the two groups, but the mean duration of ventilatory assistance for the treatment of the postextubation distress, and the length of intensive care unit stay related to this event, were both significantly shortened by noninvasive ventilation (p<0.01). In conclusion, noninvasive ventilation may be used in the management of patients with chronic obstructive pulmonary disease and postextubation hypercapnic respiratory insufficiency.

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“…In the study of BOTT et al [4], NIPSV was used for 6 days, as for patients in group I in the present study; however, respiratory acidosis was more significant for patients in the present study than in that of BOTT et al [4]. Some authors have previously proposed administering NIPSV discontinuously [1,4,5,20,23,24]. The sequential mode used on the present study is also a discontinuous mode, thus allowing comparison of the present results with those of other studies, with some specificity, i.e.…”

Section: Discussionmentioning

confidence: 50%

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

et al. 2000

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Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit.During the first 24 h after enrolment, NIPSV was used for 6.7 3.2 h (mean SD) in group I and 5.6 3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47 12 and 11 7 min in group I, and 46 12 and 11 6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7 3.2 h . day -1 in group I and 4.9 3.5 h . day -1 in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44 10 and 7 4 min in group I, and 47 14 and 7 3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients.In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency. Methods of noninvasive pressure support ventilation (NIPSV) are being proposed more and more for patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure [1±6]. NIPSV can avoid the need for endotracheal intubation and its increasingly documented complications [7]. Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2, 4, 9, 10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].Three articles have demonstrated that the institution of noninvasive mechanical ventilation is not significantly more time-consuming for personnel than traditional medical therapy [4,12] or invasive mechanical ventilation [13]. However, two of these studies [12,13] were performed in respiratory intensive care units (ICUs) with a specialized activity, and where patient/staff ratios are generally lower than in general ICUs [13]. The authors consider that the problem lies not in comparing the workload linked to utilization of NIPSV with that linked to standard treatment or invasive mechanical ventilation, since it is advisable to use NIPSV to avoid intubation. It is more a question of know...

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Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients

Abstract: Non-invasive ventilation (pressure-support) via face mask may reduce the need for tracheal intubation in the severe hypercapnic failure of COPD patients.

Cited by 80 publications

References 29 publications

Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial

Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

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