OBJECTIVE: To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders. DESIGN: An 18 months prospective cohort study. SETTING: A specialised respiratory intensive care unit in a university-affiliated hospital. PATIENTS: A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders. INTERVENTIONS: Criteria for starting non-invasive mechanical ventilation and for endotracheal intubation were predefined. Non-invasive mechanical ventilation was provided by positive pressure (NPPV) ventilators or iron lung (NPV). RESULTS: The main characteristics of patients (70% with chronic obstructive pulmonary disease) on admission were (mean, SD or median, 25th-75th centiles): pH 7.29 (0.07), PaCO(2) 83 mm Hg (19), PaO(2)/FiO(2) 198 (77), APACHE II score 19 (15-24). Among the 258 patients, 200 (77%) were treated exclusively with non-invasive mechanical ventilation (40% with NPV, 23% with NPPV, and 14% with the sequential use of both), and 35 (14%) with invasive mechanical ventilation. In patients in whom NPV or NPPV failed, the sequential use of the alternative non-invasive ventilatory technique allowed a significant reduction in the failure of non-invasive mechanical ventilation (from 23.4 to 8.8%, p=0.002, and from 25.3 to 5%, p=0.0001, respectively). In patients as a whole, the hospital mortality (21%) was lower than that estimated by APACHE II score (28%). CONCLUSIONS: Using NPV and NPPV it was possible in clinical practice to avoid endotracheal intubation in the large majority of unselected patients with acute respiratory failure on chronic respiratory disorders needing ventilatory support. The sequential use of both modalities may increase further the effectiveness of non-invasive mechanical ventilation.
OBJECTIVE: To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders. DESIGN: An 18 months prospective cohort study. SETTING: A specialised respiratory intensive care unit in a university-affiliated hospital. PATIENTS: A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders. INTERVENTIONS: Criteria for starting non-invasive mechanical ventilation and for endotracheal intubation were predefined. Non-invasive mechanical ventilation was provided by positive pressure (NPPV) ventilators or iron lung (NPV). RESULTS: The main characteristics of patients (70% with chronic obstructive pulmonary disease) on admission were (mean, SD or median, 25th-75th centiles): pH 7.29 (0.07), PaCO(2) 83 mm Hg (19), PaO(2)/FiO(2) 198 (77), APACHE II score 19 (15-24). Among the 258 patients, 200 (77%) were treated exclusively with non-invasive mechanical ventilation (40% with NPV, 23% with NPPV, and 14% with the sequential use of both), and 35 (14%) with invasive mechanical ventilation. In patients in whom NPV or NPPV failed, the sequential use of the alternative non-invasive ventilatory technique allowed a significant reduction in the failure of non-invasive mechanical ventilation (from 23.4 to 8.8%, p=0.002, and from 25.3 to 5%, p=0.0001, respectively). In patients as a whole, the hospital mortality (21%) was lower than that estimated by APACHE II score (28%). CONCLUSIONS: Using NPV and NPPV it was possible in clinical practice to avoid endotracheal intubation in the large majority of unselected patients with acute respiratory failure on chronic respiratory disorders needing ventilatory support. The sequential use of both modalities may increase further the effectiveness of non-invasive mechanical ventilation.
Authors: L Brochard; J Mancebo; M Wysocki; F Lofaso; G Conti; A Rauss; G Simonneau; S Benito; A Gasparetto; F Lemaire Journal: N Engl J Med Date: 1995-09-28 Impact factor: 91.245
Authors: Andrés Esteban; Antonio Anzueto; Fernando Frutos; Inmaculada Alía; Laurent Brochard; Thomas E Stewart; Salvador Benito; Scott K Epstein; Carlos Apezteguía; Peter Nightingale; Alejandro C Arroliga; Martin J Tobin Journal: JAMA Date: 2002-01-16 Impact factor: 56.272
Authors: E Girou; F Schortgen; C Delclaux; C Brun-Buisson; F Blot; Y Lefort; F Lemaire; L Brochard Journal: JAMA Date: 2000-11-08 Impact factor: 56.272
Authors: Christophe Girault; Anca Briel; Marie-France Hellot; Fabienne Tamion; Dominique Woinet; Jacques Leroy; Guy Bonmarchand Journal: Crit Care Med Date: 2003-02 Impact factor: 7.598
Authors: Bernd Schönhofer; Ralf Kuhlen; Peter Neumann; Michael Westhoff; Christian Berndt; Helmut Sitter Journal: Dtsch Arztebl Int Date: 2008-06-13 Impact factor: 5.594
Authors: A Corrado; M Gorini; R Melej; S Baglioni; C Mollica; G Villella; G F Consigli; M Dottorini; D Bigioni; M Toschi; A Eslami Journal: Intensive Care Med Date: 2008-11-20 Impact factor: 17.440