Intensive Care Medicine

, Volume 36, Issue 8, pp 1355–1362

Early intermittent noninvasive ventilation for acute chest syndrome in adults with sickle cell disease: a pilot study

  • Muriel Fartoukh
  • Yannick Lefort
  • Anoosha Habibi
  • Dora Bachir
  • Frédéric Galacteros
  • Bertrand Godeau
  • Bernard Maitre
  • Laurent Brochard
Original

DOI: 10.1007/s00134-010-1907-4

Cite this article as:
Fartoukh, M., Lefort, Y., Habibi, A. et al. Intensive Care Med (2010) 36: 1355. doi:10.1007/s00134-010-1907-4

Abstract

Purpose

Alveolar hypoxia and hypoxic vasoconstriction lead to trapping of sickle cells within the pulmonary vasculature. Improving alveolar ventilation and oxygenation may improve the outcome of acute chest syndrome (ACS).

Methods

Prospective randomized single-center open study from November 1998 to February 2002 to test whether noninvasive ventilation (NIV) was more effective than oxygen alone in improving oxygenation on day 3 in adults with ACS and to evaluate the effects on pain, transfusion requirements, and length of stay.

Results

Seventy-one consecutive ACS episodes in 67 patients were randomly allocated to oxygen (n = 36) or NIV (n = 35) for 3 days in a medical step-down unit. Baseline respiratory rate and pain score were higher in the NIV group. NIV promptly lowered the respiratory rate, raised \( {\text{Pa}}_{{\text{O}_{2}}} \), and decreased alveolar–arterial oxygen gradient \( (({\text{A}} - {\text{a}})_{{{\text{O}}_{ 2} }} ) \), which remained unchanged with oxygen alone. \( {\text{Pa}}_{{{\text{CO}}_{ 2} }} \) significantly worsened only in the oxygen group. On day 3, the groups did not differ regarding the proportion of episodes with normal \( {\text{Pa}}_{{{\text{O}}_{ 2} }} \) (35% with NIV and 25% with oxygen; P = 0.5) or \( (({\text{A}} - {\text{a}})_{{{\text{O}}_{ 2} }} ) \). Patient satisfaction and compliance were lower with NIV. No differences were noted in pain relief, transfusions, or length of stay. In the subgroup of patients with severe hypoxemia \( ( {\text{Pa}}_{{{\text{O}}_{ 2} }} \le 6 5\,{\text{mmHg)}} \), physiological variables also improved faster with NIV, the differences being slightly more pronounced.

Conclusions

Respiratory rate and gas exchange improved faster with NIV. However, NIV failed to significantly reduce the number of patients remaining hypoxemic at day 3, and was associated with greater patient discomfort.

Keywords

Alveolar ventilationHypoxemiaBlood transfusionsSickle cell diseaseAcute chest syndrome

Supplementary material

134_2010_1907_MOESM1_ESM.doc (214 kb)
Supplementary material (DOC 213 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Muriel Fartoukh
    • 1
  • Yannick Lefort
    • 1
  • Anoosha Habibi
    • 2
  • Dora Bachir
    • 2
  • Frédéric Galacteros
    • 2
  • Bertrand Godeau
    • 2
  • Bernard Maitre
    • 3
  • Laurent Brochard
    • 1
  1. 1.Medical Intensive Care Unit, AP-HP, Albert Chenevier-Henri Mondor Teaching HospitalINSERM U 955, Paris XII UniversityCréteilFrance
  2. 2.Sickle Cell Disease Center, AP-HP, Albert Chenevier-Henri Mondor Teaching HospitalINSERM U 955, Paris XII UniversityCréteilFrance
  3. 3.Pulmonology Unit, AP-HP, Albert Chenevier-Henri Mondor Teaching HospitalINSERM U 955, Paris XII UniversityCréteilFrance