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Is the success of positive pressure ventilation dependent on the level of care?

Objective

To report our experience with positive pressure ventilation (PPV), pressure support ventilation or assisted-controlled pressure mechanical ventilation mode, delivered by face mask (nine patients) or tracheostomy (one patient) in acute hypercapnic respiratory failure (AHRF).

Design

An observational study.

Setting

A respiratory care unit.

Patients and intervention

Ten patients with AHRF, related to bronchial superinfection or pneumonia, were treated with PPV. The mean (± standard deviation) PaCO2 and pH at entrance were, respectively, 95.96 ± 12.86 mmHg and 7.29 ± 0.05.

Results

PPV resulted in a significant improvement in PaCO2 (from 95.96 ± 12.86 mmHg to 73.72 ± 10.95 mmHg) and pH (from 7.29 ± 0.05 to 7.39 ± 0.05) within 2 hours. However, NIMV was discontinued in three patients (33%) after more than 5 days and endotracheal intubation was required because of inability to wean (one patient) or to manage bronchial secretions (two patients).

In the other patients NIMV was effective in improving PaCO2 (from 95.96 ± 12.86 mmHg to 51.16 ± 11.75 mmHg) and pH (from 7.29 ± 0.05 to 7.40 ± 0.06). Five patients continued mechanical ventilation at home.

Conclusion

Application of PPV is feasible outside the ICU, also when baseline pH should indicate admission to the ICU (pH < 7.25 in three patients) or the respiratory intermediate care unit (pH < 7.3 in one patient). Since all these patients but one avoided endotracheal intubation, whereas two patients with pH > 7.3 were intubated, arterial blood pH at entrance probably does not predict success or failure and it is not suitable to decide the level of care.

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Zito, A., Meleo, E., Chiappini, F. et al. Is the success of positive pressure ventilation dependent on the level of care?. Crit Care 9, P133 (2005). https://doi.org/10.1186/cc3196

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Keywords

  • Mechanical Ventilation
  • Endotracheal Intubation
  • Pressure Support
  • Face Mask
  • Positive Pressure Ventilation