Non-invasive mechanic ventilation in treating acute respiratory failure


Submitted: 17 February 2013
Accepted: 17 February 2013
Published: 18 December 2009
Abstract Views: 1046
PDF: 2105
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Federico Lari Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto, .
  • Novella Scandellari Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto, .
  • Ferdinando De Maria Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto, .
  • Virna Zecchi Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto, .
  • Gianpaolo Bragagni Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto, .
  • Fabrizio Giostra Medicina d’Urgenza, Azienda Ospedaliero Universitaria di Bologna, Policlinico S.Orsola Malpighi, .
  • Nicola DiBattista Medicina d’Urgenza, Azienda USL di Ravenna Ospedale per gli Infermi di Faenza, .
Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease (COPD), Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS). NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5%) met primary endpoint (NIV failure): 11 Pts (17%) needed ETI (5ALI/ARDS p < 0,0001, 6COPD 16,6%), 1 Patient (1,5%) died (Pneumonia). No Pts with ACPE failed (p = 0,0027). Secondary endpoints: significant improvement in Respiratory Rate (RR), Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff’s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting.

Federico Lari, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto
Novella Scandellari, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto
Ferdinando De Maria, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto
Virna Zecchi, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto
Gianpaolo Bragagni, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto
Fabrizio Giostra, Medicina d’Urgenza, Azienda Ospedaliero Universitaria di Bologna, Policlinico S.Orsola Malpighi
Nicola DiBattista, Medicina d’Urgenza, Azienda USL di Ravenna Ospedale per gli Infermi di Faenza
Lari, F., Scandellari, N., De Maria, F., Zecchi, V., Bragagni, G., Giostra, F., & DiBattista, N. (2009). Non-invasive mechanic ventilation in treating acute respiratory failure. Emergency Care Journal, 5(6), 8–20. https://doi.org/10.4081/ecj.2009.6.8

Downloads

Download data is not yet available.

Citations