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Non-invasive ventilation in hypercapnic coma

Report by: Huw Masson, CT3 Emergency Medicine

Search checked by: Mike Hockey, Emergency Medicine Consultant

Institution: Scunthorpe General Hospital, Scunthorpe General Hospital, Scunthorpe, UK

Clinical scenario

A 78-year-old female with long standing heart failure (New York Heart Association grade 3) is brought to the Emergency Department (ED) with respiratory distress and reduced conscious level. Arterial blood gas analysis demonstrates that the patient has type 2 respiratory failure and she scores 5/15 on the Glasgow Coma Scale (GCS). An opinion is sought from the Intensive Care Unit (ICU) physicians regarding the prospect of invasive mechanical ventilation (IMV), but they decide that the patient is not suitable for IMV. You consider instituting non-invasive ventilation (NIV). However, a depressed level of consciousness is traditionally thought to be a contraindication to NIV. This makes you wonder whether it would be an appropriate management strategy in this situation.

Three-part question

In [adults with acute respiratory failure and hypercapnic coma] does [non-invasive ventilation] lead to [improved outcome]?

Search strategy

Medline 1950–2010 May Week 4 and EMBASE 1980–2010 Week 22, via the Ovid interface.

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  • Provenance and peer review Not commissioned; not externally peer reviewed.