Background: There is increasing support for the
use of noninvasive positive pressure ventilation (NPPV) in the
treatment of patients with acute respiratory failure. Highest success
rates are recorded in patients with exacerbation of COPD, particularly
in patients presenting primarily with hypercarbic respiratory failure.
Success has been more limited in patients with acute hypoxemic
respiratory failure, and there are few reports of NPPV in patients with
acute lung injury (ALI) or ARDS.
Objectives: We report
the outcome of 12 episodes of ALI/ARDS in 10 patients treated with
Design: Experiential cohort study.
Setting: Tertiary referral center and university hospital
Intervention: Provision of NPPV in patients with
Results: Group median (range) APACHE (acute
physiology and chronic health evaluation) II score was 16 (11 to 29).
Success rate (avoidance of intubation and no further assisted
ventilation for 72 h) was achieved on six of nine occasions (66%)
when NPPV was used as the initial mode of assisted ventilation. It
failed after three episodes of planned (1) or self (2) extubation.
Duration of successful NPPV was 64.5 h (23.5 to 80.5 h) with
ICU discharge in the next 24 to 48 h for three of six patients.
Unsuccessful episodes lasted 7.3 h (0.1 to 116 h) with need
for conventional ventilation for an additional 5 days (2.7 to 14 days).
Survival (ICU and hospital) for the 10 patients was 70%.
Conclusions: In a group of hemodynamically stable patients
with severe ALI, NPPV had a high success rate. NPPV should be
considered as a treatment option for patients in stable condition in
the early phase of ALI/ARDS.
Abbreviations: ALI = acute lung injury;
APACHE = acute physiology and chronic health evaluation;
CPAP = continuous positive airway pressure; CXR = chest radiograph;
Fio2 = fraction of inspired oxygen;
IPPV = intermittent positive pressure ventilation;
NPPV = noninvasive positive pressure ventilation; PEEP = positive