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Critical Care |

The Use of Invasive Continuous Positive Airway Pressure for Low Tidal Volume Ventilation

Shilpa Patel*, MD; Casey Stahlheber, MD; Troy Whitacre, RRT; Dexter Burns, RRT; Stevan Whitt, MD
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University of Missouri, Columbia, MO


Chest. 2012;142(4_MeetingAbstracts):374A. doi:10.1378/chest.1382192
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Abstract

SESSION TYPE: ARDS/Lung Injury Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: A subset of spontaneously breathing patients with adult respiratory distress syndrome (ARDS)/acute lung injury (ALI) achieves low tidal volume goals only when delta pressure is titrated downward to continuous positive airway pressure (CPAP). We performed a retrospective observational study to assess the safety of CPAP alone for invasively mechanically ventilated, spontaneously breathing patients with ARDS/ALI.

METHODS: The records of all adult patients with respiratory failure and a PaO2/FiO2 (P/F) ratio < 300 who were invasively ventilated using CPAP at the University of Missouri Hospital between 8/1/2008 and 11/7/2009 were reviewed. Patients undergoing active weaning were excluded. Sedation requirements, respiratory rate and P/F ratio were compared in individual patients ventilated using CPAP versus conventional modes.

RESULTS: 23 patients were included (13 males and 10 females: age range of 19 to 78 years). The mean BMI was 36 kg/m2. The median time on CPAP was 51 hours. No difference was seen in the mean respiratory rate (18.8 vs. 18.78; p=0.99 ) or sedation requirements [propofol (15.0 vs. 19.5; p= 0.48), ativan (0.02 vs. 0.07; p= 0.54), versed(0.76 vs. 1.11; p= 0.41) or fentanyl(79.4 vs. 92.1; p= 0.54)] using CPAP vs. conventional modes respectively. P/F ratio was slightly better (183.80 vs 209.72; p=0.02) and survival was 87% (vs. 40-74% historical control) in the CPAP group.

CONCLUSIONS: Invasive CPAP appears safe and well tolerated in spontaneously breathing patients with ARDS/ALI.

CLINICAL IMPLICATIONS: Invasive CPAP may be a useful mode in patients with ARDS/ALI.

DISCLOSURE: The following authors have nothing to disclose: Shilpa Patel, Casey Stahlheber, Troy Whitacre, Dexter Burns, Stevan Whitt

No Product/Research Disclosure Information

University of Missouri, Columbia, MO

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