Abstract
Objective
To test whether non-invasive ventilation via facial mask could reduce the need for tracheal intubation via when mechanical ventilation must be initiated in COPD patients.
Design
Open prospective interventional study.
Setting
General Intensive Care Service of a County Hospital.
Patients
We have studied 12 COPD patients during 14 episodes of acute exacerbation of chronic respiratory failure who failed to improve with intensive medical therapy and showed impairements in severe respiratory acidosis and/or hypercapnic encephalopathy leading their attending physicians to order mechanical ventilation
Interventions
In these circumstances, a trial of pressuresupport (PS) ventilation (Servo Ventilator 900Cℜ) via facial mask Vital Signs Inc.ℜ) was performed. The level of pressure support was adjusted to obtain a tidal volume>400 ml. If the patient deteriorated, tracheal intubation and standard mechanical ventilation were performed.
Measurements and results
Measurements are presented as means±SEM. A pressure-support level of 14±3 cmH2O was used during a period of 8±4 h. Low levels of external PEEP were used in 4 patients, while it generated excessive leaks in the others. Significant differences (p<0.05 ANOVA for repeated measures) in data obtained on admission, when patients deteriorated and after pressure support was administered were only observed in PaCO2 (68±3 versus 92±3 versus 67±3 mmHg), arterial pH (7.27±0.03 versus 7.19±0.02 versus 7.31±0.01). SaO2 (60±4 versus 86±3 versus 92±1%) and respiratory rate (35±2 versus 32±2 versus 23±1 breaths·min−1). Three patients needed intubation and one of them died in the ICU.
Conclusion
Non-invasive ventilation (pressure-support) via face mask may reduce the need for tracheal intubation in the severe hypercapnic failure of COPD patients.
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Fernandez, R., Blanch, L., Valles, J. et al. Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients. Intensive Care Med 19, 456–461 (1993). https://doi.org/10.1007/BF01711087
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DOI: https://doi.org/10.1007/BF01711087