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Clinical Investigations in Critical CareThe Use of Noninvasive Positive Pressure Ventilation in the Emergency Department: Results of a Randomized Clinical Trial
Section snippets
Study Location and Patients
The study was conducted in an urban university-affiliated teaching hospital, Barnes-Jewish Hospital (900 beds). During a 6-month period (July 1996 to December 1996), patients with acute respiratory distress in the ED were potentially eligible for this investigation. Patients were entered into the study if they were older than 18 years and had evidence of acute respiratory distress as demonstrated by the acute onset of moderate to severe dyspnea as assessed by the ED attending physician; a
Patients
Of the 87 patients evaluated in the ED for acute respiratory distress during the study period, 27 (31.0%) were enrolled into the study. Of the remaining 60 patients not enrolled in this investigation, 34 (56.7%) required emergent tracheal intubation in the ED, 2 (3.3%) had a tracheostomy, 11 (18.3%) had asthma, and 13 (21.7%) were not enrolled due to human error. Sixteen (59.3%) of the study patients were randomized to receive conventional medical therapy plus NPPV, and 11 (40.7%) patients were
DISCUSSION
This preliminary study demonstrated no difference in the need for endotracheal intubation and mechanical ventilation among patients with acute respiratory distress in the ED receiving conventional medical therapy alone vs conventional medical therapy plus NPPV. However, we unexpectedly found a troubling trend towards increased hospital mortality among patients receiving NPPV (25.0% vs 0.0% in patients receiving conventional medical therapy alone). Our study also demonstrated no significant
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This research was supported in part by a grant from the American Lung Association of Eastern Missouri.