Use of a Ventilatory Support System (Bi PAP) for Acute Respiratory Failure in the Emergency Department

Poponick, Janet; Renston, Jeffrey P.; Bennett, Richard P.; Emerman, Charles L.

doi:10.1378/chest.116.1.166

Cited by 101 publications

(64 citation statements)

References 18 publications

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“…NIV has previously been assessed in this role and found to be of use as an initial treatment, with the option of intubation should treatment fail. 5 Plant et al 4 concur with previous studies that the most important initial data predicting the need for intubation and mortality are the degree of acidosis and level of hypercapnia. [6][7][8] It seems reasonable to assume that the earlier NIV is commenced, provided it is used appropriately, the better the outcome will be.…”

Section: Non-invasive Ventilationsupporting

confidence: 53%

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Noninvasive Ventilation

Sidhu

Simonds²

2015

Encyclopedia of Trauma Care

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Section: Non-invasive Ventilationsupporting

confidence: 53%

“…5 In fact, Plant et al did not analyse all possible variables. In particular, they did not look at those which we found to be of great predictive value-namely, the evolution of the arterial gases after a short session of ventilation.…”

mentioning

confidence: 99%

Noninvasive Ventilation

Sidhu

Simonds²

2015

Encyclopedia of Trauma Care

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“…7 Bilevel positive airway pressure is increasingly promoted in the emergency department and recently suggested by one case experience, but we would warn against its indiscriminate use in Guillain Barré syndrome and call for a prospective study. 4,8 There is no systematic study on the use of BiPAP in weaning of patients with Guillain-Barré syndrome nor its use in patients with less rapid deterioration in weakness. In the acute phase of GBS, it is likely that the involvement of the diaphragm and other inspiratory muscles are of such a severity that only volumetriggered ventilation can adequately support these patients.…”

Section: Discussionmentioning

confidence: 99%

BiPAP in Early Guillain-Barré Syndrome May Fail

Wijdicks

Roy

2006

Can J Neurol Sci.

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Non-invasive mechanical ventilation using bilevel positive airway pressure provides cycles of pressure-support ventilation in the inspiratory phase and positive end-expiratory pressure in the expiratory phase. Bilevel positive airway pressure has emerged as an alternative to endotracheal intubation and mechanical ventilation in primary pulmonary disorders. 1 Concern about the morbidity of mechanical ventilation has resulted in increased use of BiPAP. In acute neurologic diseases, BiPAP can provide ventilatory assistance in myasthenic crises while awaiting the effect of plasma exchange. 2 Nasal mask continuous positive air pressure has been used in patients with bilateral diaphragmatic paralysis after heart surgery and one successful attempt to prevent intubation is on record in GuillainBarré syndrome. 3,4 Neuromuscular respiratory failure is present in 30% of patients with Guillain-Barré syndrome. In patients with marginal respiratory function who are not necessarily candidates for immediate intubation, BiPAP could theoretically be a useful, temporary assisting device. The decreased workload of breathing leads not only to marked improvement in patient comfort but also to improved gas exchange. We have recently used BiPAP in two patients with Guillain-Barré syndrome but report its failure, and worse, emergency intubation in both of these patients. ABSTRACT:Background: Non-invasive mechanical ventilation (BiPAP) has been introduced for use in neuromuscular respiratory disease such as amyotrophic lateral sclerosis and myasthenia gravis. There is no experience in Guillain-Barré syndrome. Methods: We describe for the first time the use of BiPAP to assist in the work of breathing in two consecutive patients with progressing Guillain-Barré syndrome (GBS) and marginal pulmonary function. Results: Our initial attempts to use BiPAP in GBS and early neuromuscular respiratory failure were totally unsuccessful. There was marked initial improvement; however, emergency intubation was needed in both patients, one of which became acutely cyanotic. Conclusions: Until more experience is available, we strongly warn against using BiPAP in deteriorating patients with GBS.RÉSUMÉ: Le système BiPAP peut échouer dans le syndrome de Guillain-Barré en phase précoce. Contexte: La ventilation mécanique non effractive (BiPAP) est utilisée dans les maladies neuromusculaires avec atteinte respiratoire comme la sclérose latérale amyotrophique et la myasthénie grave. Cependant, il n'y a pas de données sur le syndrome de Guillain-Barré (SGB). Méthodes: Nous décrivons pour la première fois l'utilisation du BiPAP pour fournir une assistance respiratoire chez deux patients consécutifs présentant un (SGB) évolutif et une fonction pulmonaire limite. Résultats: Nos premières tentatives d'utilisation du BiPAP dans le SGB avec insuffisance respiratoire neuromusculaire au début se sont soldées par un échec. L'amélioration initiale était importante, cependant une intubation d'urgence s'est avérée nécessaire chez les deux patients, dont un est devenu subitem...

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“…Endotracheal intubation is often required. However, recent data (85,86) suggest that judicious use of noninvasive ventilation, including continuous positive airway pressure and bilevel positive airway pressure, may obviate the need for intubations in up to 75% of cases.…”

Section: Assisted Ventilationmentioning

confidence: 99%