Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

Abstract

Background:Patients with acute pancreatitis (AP) who require mechanical ventilation have high morbidity and mortality rates. Noninvasive positive pressure ventilation (NPPV) delivered through a mask has become increasingly popular for the treatment of acute respiratory failure (ARF) and may limit some mechanical ventilation complications. Objectives: The purpose of this retrospective, observational study was to evaluate our clinical experience with the use of NPPV in AP patients with ARF. Methods: From 1997 to 2003, we documented clinical data, gas exchange and outcome of the 62 AP patients admitted to our intensive care unit. Patients who benefited from NPPV (success) were compared with those who failed (intubated). Results:Twenty-nine patients were intubated at admission and 5 did not develop ARF. Of the 28 patients treated with NPPV, 15 were not intubated (54%). Both groups had a similar PaO₂/FiO₂ ratio (142 ± 21 vs. 133 ± 20; p = 0.127) and severity of illness (Ranson and Balthazar scores). Presence of atelectasis, bilateral alveolar infiltrates and abdominal distension were associated with failure of NPPV. Oxygenation improved and respiratory rate decreased significantly only in the success group. Additionally, the length of stay at the intensive care unit was significantly lower in the success group. Conclusion: NPPV is feasible and safe to treat ARF in selected patients with AP who require ventilatory support.

Intra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation

“…Such patients have a mortality rate of more than 50% in the first week of admission to intensive care, if they require invasive ventilation [9]. Shields et al [10] reviewed comprehensively the mechanisms leading to acute lung injury in SAP.…”

Treatment-Related Risk Factors for Development of Skin Breakdown in Subjects With Acute Respiratory Failure Undergoing Noninvasive Ventilation or CPAP

“…4,5 The main clinical indications for the use of NIV are directed to the treatment of COPD exacerbation, acute pulmonary edema, pulmonary infection in immunosuppressed subjects, and, in some specific cases, acute pancreatitis. [6][7][8][9][10][11][12] NIV has also been employed to prevent re-intubation in subjects who developed postextubation respiratory failure and to shorten the duration of invasive mechanical ventilation by facilitating weaning (earlier extubation). 13,14 Although the use of NIV improves clinical outcomes, some complications and deleterious effects have also been recognized in clinical practice, such as aspiration, hemodynamic instability, dryness of secretions, and patientventilator asynchrony.…”

Ventilação mecânica não invasiva em uma paciente com pancreatite aguda e insuficiência respiratória

“…The most common pleuropulmonary complications of acute pancreatitis are inflammatory response syndrome, atelectasis, alveolar consolidation, and diaphragmatic dysfunction. (1,2) Noninvasive mechanical ventilation (NIMV) is an advance in intensive care in specific cases of acute respiratory failure, such as in COPD exacerbation and in cardiogenic pulmonary edema.(3) In such cases, NIMV is used in order to reduce the work of breathing and improve pulmonary gas exchange, as well as to avoid tracheal intubation. In the Adult ICU of the State University at Campinas Hospital de Clínicas, located in the city of Campinas, Brazil, we had the opportunity to treat a 35-year-old female patient who had been admitted with a diagnosis of acute biliary pancreatitis and signs of respiratory failure.…”

“…(3) Ventilatory support by NIMV is safe and efficient as long as patients are closely monitored and promptly intubated if their clinical condition deteriorates; however, when used incorrectly, NIMV can delay the use of invasive mechanical ventilation and increase mortality. (1,3) In conclusion, NIMV can be part of the therapeutic armamentarium for patients with acute pancreatitis and respiratory failure as long as there are no contraindications to its use and patients are closely monitored. …”