Noninvasive positive pressure ventilation in acute respiratory failure: does it improve outcomes?

Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Cleveland Clinic Journal of Medicine (Impact Factor: 3.4). 09/2001; 68(8):677-80. DOI:10.3949/ccjm.68.8.677
Source: PubMed

ABSTRACT Studies have shown that noninvasive positive pressure ventilation (NPPV) is well tolerated and safe, and that it improves oxygenation in some patients with acute respiratory failure. By obviating the need for endotracheal intubation in certain conditions, it results in fewer complications, shorter hospital stays, and consequently, lower mortality rates and costs of care.

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    ABSTRACT: RIASSUNTO La ventilazione a pressione positiva continua è una tecnica che permette di mantenere una pressione positiva all’interno delle vie aeree per tutto il ciclo respiratorio durante la ventilazione spontanea, mantenendo la pervietà delle vie aeree inferiori, in quelle condizioni che provocano il collasso degli alveoli. In questo lavoro è stata valutata la possibilità di applicare la ventilazione a pressione positiva continua con una tecnica di ventilazione non invasiva, mediante l’impiego di una valvola applicata ad una maschera per ossigenoterapia. Nello studio sono stati inseriti 5 cani di proprietà giunti al Dipartimento di Clinica Veterinaria per accertamenti diagnostici ed interventi chirurgici. Lo scopo di questo lavoro è stato quello di valutare la tollerabilità dei soggetti a questa metodica e l’efficacia rispetto ad una comune tecnica di ossigenoterapia in maschera. I cinque soggetti sono stati sottoposti ad ossigenoterapia in maschera con ventilazione spontanea e successivamente a ventilazione a pressione positiva con una pressione di 5 cm H2O. Durante la procedura sono stati monitorizzati frequenza cardiaca, frequenza respiratoria, pressione arteriosa media e temperatura. Per la valutazione dell’ossigenazione dei soggetti sono stati valutati, mediante emogas su sangue arterioso, pH, pressione parziale di ossigeno e di anidride carbonica. Riguardo alla valutazione della tollerabilità del sistema di ventilazione a pressione positiva continua in tutti i cani è stato possibile applicare la maschera raggiungendo la pressione desiderata senza avere reazioni di irrequietezza e senza l’insorgenza di dilatazione gastrica per ingestione di aria od ossigeno. Lo studio dell’efficacia ha dimostrato il raggiungimento di pressione parziale di ossigeno e di frazioni inspirate di ossigeno superiori con la tecnica con ventilazione a pressione positiva continua non invasiva, rispetto alla tecnica di ossigenoterapia classica. SUMMARY Continuous positive airways pressure is a ventilation technique used when it is necessary to sustain a positive pressure during the entire respiratory cycle in spontaneous ventilation. This method is indicated to maintain airways patency especially in condition of alveoli collapse. The object of this study was to evaluate the tolerability of a non invasive continuous positive airway pressure with a mask device in lightly sedated dogs and to compare the oxygen inspired fraction between oxygen therapy with regular mask device and between continuous positive airway pressure ventilation with mask device. Five client-owned dogs, that arrived to the Clinic in order to attempt surgical or diagnostic techniques, were enrolled in the study. Dogs received oxygen with a regular mask device with an open system and with continuous positive airway pressure ventilation at 5 cm H2O pressure ventilation. During the procedures dogs were monitored recording heart rate, respiratory rate, mean arterial pressure and temperature. For the comparison of the patients oxygenation between the two methods had been used the evaluation of blood gas analysis recording partial pressure of arterial oxygen, of carbon oxide and pH. In all dogs was possible to apply the continuous positive airway pressure ventilation with mask device without evidence of agitation, panic or gastric distension due to gas ingestion. Recorded values of partial pressure of arterial oxygen and calculated values of oxygen inspired fraction were considerably higher with non invasive continuous positive airway pressure ventilation technique compared to classic oxygen therapy method.
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Alejandro C Arroliga