Chest
Volume 107, Issue 3, March 1995, Pages 761-768
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Clinical Investigations in Critical Care: Articles
Noninvasive Pressure Support Ventilation in Patients With Acute Respiratory Failure: A Randomized Comparison With Conventional Therapy

https://doi.org/10.1378/chest.107.3.761Get rights and content

The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to receive conventional therapy (n=20) or conventional therapy plus NIPSV (n=21). NIPSV was delivered to the patient by a face mask connected to a ventilator (Puritan-Bennett 7200a) set in inspiratory pressure support (IPS) mode. The mean levels of IPS, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FI02) were respectively 15 ± 3 cm H2O, 4 ± 2 cm H2O, and 57 ± 22%. The rate of endotracheal intubation (62 vs 70%, p=0.88), the length of ICU stay (17 ± 19 days vs 25 ± 23 days, p=0.16), and the mortality rate (33 vs 50%, p=0.46) were not different between patients treated with NIPSV and those treated conventionally. Post hoc analysis suggested that in patients with PaCO2 >45 mm Hg (n=17), NIPSV was associated with a reduction in the rate of endotracheal intubation (36 vs 100%, p=0.02), in the length of ICU stay (13 ± 15 days vs 32 ± 30 days, p=0.04), and in the mortality rate (9 vs 66%, p=0.06). We conclude that NIPSV is of no benefit when used systematically in all forms of acute respiratory failure not related to COPD. A subgroup of patients, characterized by acute ventilatory failure and hypercapnia, may potentially benefit from this therapy and further studies are needed to focus on this aspect.

Section snippets

Methods

Informed consent was obtained from the patient or next of kin as soon as possible after the patient was identified.

Results

Between July 16, 1990, and October 16, 1992, respiratory distress occurred in 116 nonintubated patients hospitalized in our ICU. Seventy-five (64%) were not enrolled in this study: 30 of them (40%) because of respiratory distress due to an acute exacerbation of chronic respiratory failure, 16 (21%) because of respiratory distress due to a neurologic disease, 16 (21%) because of more than two organ failures, 8 (10%) because of endotracheal intubation urgently required for cardiac arrest, 2 (3%)

Discussion

The main finding of the present study is that in patients admitted to the ICU with acute respiratory failure not due to chronic obstructive pulmonary disease, the use of NIPSV did not significantly reduce the rate of endotracheal intubation, the length of ICU stay, and the mortality rate. In the subgroup of patients admitted with hypercapnic respiratory failure, NIPSV may have some beneficial effects. The design of the study, however, did not allow us to draw definitive conclusions in this

ACKNOWLEDGMENTS

We are indebted to Mrs A. Le Mitouard for her technical assistance concerning the face mask. The writers wish to thank Pr. L. Brochard for thoughtful review of the manuscript and the nursing and medical staff of the ICU of the Hôpital International de l’Université de Paris for their collaboration in this study.

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