Comparison of mask and nasal continuous positive airway pressure after extubation and mechanical ventilation

Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure. M. Wysocki, M. Antonelli. #ERS Journals Ltd 2001. ABSTRACT: In acute hypoxaemic respiratory failure (HRF), oxygenation, reduction in the work of breathing and in dyspnoea may be achieved by delivering noninvasive mechanical ventilation (NIMV).Several uncontrolled and 13 randomized controlled studies (RCS) were reviewed. Uncontrolled studies confirmed the feasibility and the possibility to improve arterial blood oxygenation with NIMV. The 13 RCS compared NIMV versus a conventional approach in a total of 720 patients with HRF. Endotracheal intubation was required in 186 of the 358 patients (median (95% confidence interval (CI)) 51%, (40-63%)) assigned to a conventional approach and in 107 of the 362 patients (29% (20-39%)) assigned to NIMV. Eleven of the 13 RCS found a reduction in the rate of endotracheal intubation with NIMV with an absolute risk reduction of 31% (30-33%).Ten of the 13 RCS found a reduction in the mortality rate which was 30% (19-40%) in the control group and 19% (13-26%) in the NIMV group. The mean absolute risk reduction was 15% (10-20%).In conclusion, noninvasive ventilation appears to be a useful method in avoiding endotracheal intubation and probably in reducing the morbidity of patients with hypoxaemic respiratory failure.

Section: The Masksupporting

confidence: 82%

Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure

Wysocki

Antonelli

2001

“…These include increased vital capacity [39], reduced respiratory rate [40], reduced minute ventilation [41] and increased functional residual capacity (FRC) [39,40,42,43]. The increased FRC leads to a reduction in shunt, improved arterial saturation and lung compliance, and a decrease in the work of breathing [44±46].…”

Section: Physiological Effectsmentioning

confidence: 99%

“…Masks need to ®t so that an effective seal is obtained, air leaks around the mask are permissible provided the airway pressure is maintained [68]. PUTENSEN et al [40] found no difference in ef®cacy of CPAP when a nasal and face mask were compared in 10 patients postextubation.…”

Section: Equipmentmentioning

confidence: 99%

The use of positive pressure devices by physiotherapists

Denehy

Berney²

2001

The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

“…The issue of whether mask continuous positive airway pressure (CPAP) should be considered as NIV is debatable but it has been used in ARF [28][29][30][31][32], during weaning [33] and for postextubation respiratory failure [34][35][36]. In patients with restrictive lung disease it improves oxygenation and reduces the work of breathing by recruiting atelectatic lung, improving ventilation/perfusion relationships and increasing functional residual capacity.…”

Section: Respiratory Failure Due To Lung Diseasementioning

confidence: 99%

“…35) and tachypnoea (respiratory rate w23 breaths?min -1 ) after initial medical therapy. There is less clinical-trial data in patients with hypoxaemic respiratory failure, but again as with COPD those with less severe physiological disturbance are more likely to benefit.…”

mentioning

confidence: 99%

Noninvasive ventilation for acute respiratory failure

Brochard

Mancebo²,

Elliott³

2002

Noninvasive ventilation (NIV) has emerged as a significant advance in the management of respiratory failure. There is now a wide body of prospective randomized-controlled trial data to support its use, particularly in the management of patients with acute or respiratory failure due to exacerbations of chronic obstructive pulmonary disease (COPD). Its successful application results in a more rapid resolution of the physiological derangements, reduces the need for intubation and, in larger studies, improves survival. A reduction in the number of infectious complications is a particular advantage.In patients with acute exacerbations of COPD there is evidence of benefit when NIV is introduced earlier in the course of the illness than would be the case for invasive ventilation and it should now be considered even with mild acidosis (pH<7.35) and tachypnoea (respiratory rate >23 breaths·min−1) after initial medical therapy.There is less clinical-trial data in patients with hypoxaemic respiratory failure, but again as with COPD those with less severe physiological disturbance are more likely to benefit. By contrast noninvasive continuous positive airways pressure, while being widely used has not been shown to reduce the need for intubation or to improve survival in patients with hypoxaemic respiratory failure, with the exception of acute cardiogenic pulmonary oedema.Noninvasive ventilation has been a real advance in the treatment of the critically ill. Most of the studies published to date, have excluded patients needing immediate intubation and it should be viewed as a complimentary technique rather than an alternative to invasive ventilation. It is best viewed as a means of preventing the need for endotracheal intubation and as a result should be introduced earlier than would be the case for invasive ventilation.