Chest
Volume 95, Issue 4, April 1989, Pages 865-870
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Clinical Investigations in Critical Care
Noninvasive Face Mask Ventilation in Patients with Acute Respiratory Failure

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Noninvasive face mask ventilation has been used successfully in patients with paralytic respiratory failure. This study evaluated whether noninvasive face mask ventilation can be used for patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia and four with hypoxemic acute respiratory failure met clinical and objective criteria for mechanical ventilation, which was delivered with pressure control and pressure support via a tightly strapped, clear face mask. No patient terminated the study because of inability to deliver adequate ventilation or to improve oxygen exchange; three eventually required endotracheal intubation. The mask was generally well tolerated. All patients had a nasogastric tube placed on suction, and none vomited or aspirated. The mean duration of treatment was 33 h (range, 3 to 88). The physiologic response was considered similar to that which would have been achieved with conventionally delivered ventilation. Noninvasive face mask ventilation may have a role in managing respiratory failure.

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MATERIAL AND METHOD

Patients with acute hypoxemic or hypercapneic respiratory failure nonselectively entered the study from April 1987 to June 1988 if they met clinical and physiologic parameters indicating the need for mechanical ventilation. The protocol was approved by the Institutional Review Board.

Diagnostic criteria for hypercapnic respiratory failure were severe difficulty in breathing as expressed by the patient, hypercapnia, acute respiratory acidosis with a respiratory rate more than 30 breaths/min, and

RESULTS

Ten patients with acute respiratory failure entered the study (Table 1). Six had COPD with acute ventilatory failure, and four had refractory hypoxemia of different etiologies. Two patients who met the entrance criteria were unable to participate in the study because of the inability to find a mask that properly fit their facial contour.

DISCUSSION

Mechanical ventilation is a lifesaving support measure for patients with respiratory failure. Its primary purposes are to achieve adequate alveolar ventilation and to improve oxygen exchange. Traditionally, inserting an endotracheal tube is needed to deliver the mechanical tidal breath. Complications can result from the intubation procedure, either while the tube is in place or after extubation.11, 12

Placement of a tube in the oral cavity and the inability of patients to verbalize are

ACKNOWLEDGMENT

The authors wish to thank the respiratory therapists and the Pulmonary attendings of Norwalk Hospital for their dedication and enthusiasm that have made this study possible. We would like to acknowledge the assistance of Dr. Norman Soskel and Dr. David Armbruster in editing the manuscript, Nancy Smith and Vicky Franke for secretarial support, and Denis Selmont, PhD, for organizing Table 1, Table 2, Table 3.

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Presented in abstract form at the 54th Annual Scientific Assembly, American College of Chest Physicians, Anaheim, Oct 3-7, 1988.

Manuscript received October 31; revision accepted December 9.

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