Chest
Volume 115, Issue 1, January 1999, Pages 173-177
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Clinical Investigations in Critical Care
Noninvasive Positive Pressure Ventilation: Successful Outcome in Patients With Acute Lung Injury/ARDS

https://doi.org/10.1378/chest.115.1.173Get rights and content

Background

There is increasing support for the use of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory failure. Highest success rates are recorded in patients with exacerbation of COPD, particularly in patients presenting primarily with hypercarbic respiratory failure. Success has been more limited in patients with acute hypoxemic respiratory failure, and there are few reports of NPPV in patients with acute lung injury (ALI) or ARDS.

Objectives

We report the outcome of 12 episodes of ALI/ARDS in 10 patients treated with NPPV.

Design

Experiential cohort study.

Setting

Tertiary referral center and university hospital ICU.

Intervention

Provision of NPPV in patients with ALI/ARDS.

Results

Group median (range) APACHE (acute physiology and chronic health evaluation) II score was 16 (11 to 29). Success rate (avoidance of intubation and no further assisted ventilation for 72 h) was achieved on six of nine occasions (66%) when NPPV was used as the initial mode of assisted ventilation. It failed after three episodes of planned (1) or self (2) extubation. Duration of successful NPPV was 64.5 h (23.5 to 80.5 h) with ICU discharge in the next 24 to 48 h for three of six patients. Unsuccessful episodes lasted 7.3 h (0.1 to 116 h) with need for conventional ventilation for an additional 5 days (2.7 to 14 days). Survival (ICU and hospital) for the 10 patients was 70%.

Conclusions

In a group of hemodynamically stable patients with severe ALI, NPPV had a high success rate. NPPV should be considered as a treatment option for patients in stable condition in the early phase of ALI/ARDS.

Section snippets

Materials and Methods

Between August 1, 1994, and July 31, 1996, the efficacy of NPPV was assessed on 108 occasions in patients with acute hypoxemic and/or hypercapnic respiratory failure at the Victoria General Site of the QE II Health Sciences Centre, Halifax, Nova Scotia, a tertiary referral center for the Maritime Provinces of Eastern Canada. Ten patients (3 male, 7 female, mean age 47 years, range 25 to 89 years) met the American-European diagnostic criteria for ALI/ARDS6 and received NPPV on 12 occasions. In

Results

Overall patient survival was 70% (7 of 10) with three ICU deaths occurring 5, 8, and 16 days after ICU admission. Overall success rate for NPPV trials was 6 of 12 (50%). When used as a de novotherapy, it was more successful (six of nine occasions), with failure in all three patients in whom NPPV was tried following self-extubation (n = 2) after 0.1 and 1.15 h and once after planned extubation. Two patients underwent a trial of NPPV on two occasions with one success and one failure at the second

Discussion

Within the constraints of an experiential pilot study, this report describes a surprisingly high success rate of NPPV (with pressure support) in patients with ALI/ARDS. Since the description by Ashbaugh et al15 of acute respiratory distress in adults and its treatment with PEEP, the conventional approach to assisted ventilation in patients with ALI/ARDS has been the provision of endotracheal intubation and IPPV. Both of these interventions are associated with several potential complications

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    The Lung Association of Nova Scotia provided support.

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