Chest
Volume 100, Issue 5, November 1991, Pages 1371-1376
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Clinical Investigations in Critical Care
Pressure Support Ventilation with a Simplified Ventilatory Support System Administered with a Nasal Mask in Patients with Respiratory Failure

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Thirty-one consecutive patients with respiratory failure in whom treatment with intubation and mechanical ventilation was being strongly considered received alternative ventilatory support by means of a BiPAP ventilatory support system and nasal mask. Laboratory measurements and physical findings were documented before and 1 h after initiation of support. This support improved patient comfort, slowed respiratory rate, and improved oxygenation. Support lasted from 2 h to six days. Seventy-six percent (22/29) of patients recovered from this episode of respiratory failure, avoiding alternative mechanical ventilatory support. There were no complications associated with aspiration, gastric distention, or acute separation from support.

Section snippets

Patient Selection

Patients in either the surgical or medical intensive care units at Allegheny General Hospital were identified by their attending physicians as in need of intubation and mechanical ventilatory support. Surgical patients were excluded if less than 36 h had elapsed since the operation to exclude those whose respiratory problem was caused by premature extubation. The patients were further screened for entry into the study by using the criteria of hemodynamic stability and one or both of the

Results

Characteristics of the 31 study patients, along with their baseline arterial blood gas values, O2 saturation, respiratory rate, and personal assessment of their ventilation, are given in Table 2. Also listed are the FIo2, the EPAP and IPAP level chosen on initial adjustment, and the ultimate duration of BiPAP support.

The average values of measurements derived from physical examination and laboratory data before BiPAP and 1 h after administration are given in Table 3.

After a period of

Discussion

The results of this study demonstrated that, in selected patients with respiratory failure, the institution of BiPAP ventilatory support with nasal mask can be used successfully. The avoidance of intubation was considered to be an important goal for improvement of patient comfort. A simple ventilatory support system (relative to the more complicated, conventional mechanical ventilator) provided PSV.

Acutely this support provided improved patient comfort, slower respiration rate, and improved

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