Non-Invasive Positive Pressure Ventilation in Acute Hypercapnic Respiratory Failure: Ten-Year’s Clinical Experience of a Respiratory Semi-Intensive Care Unit

Abstract

BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIPPV) in selected cases of acute hypercapnic respiratory failure (ARF) in setting with different care levels, clinical practice data about the use of VNI in the “real world” are limited.AimTo report the results of our clinical experiencein NIPPV applied for ARF in the Respiratory Semi-Intensive Care Unit (UTSIR) allocated within the Respiratory Division of Arezzo betweenthe years 1996-2006 in terms of: patient tolerance, effects upon arterial blood gases, successrate and predictors of failure. Methods: Three hundred and filthy out of the 1484 patients (23.6%) consecutively admittedfor ARF to our Respiratory Division during the study period received NIPPV in addition to standard therapy, according to the predeterminedroutinely used criteria. Results: Eight patients (2.3%) did not tolerateNIPPV because of mask discomfort, while the remaining 342 (M: 240, F: 102); median (interquartiles)age: 74.0 (68.0-79.3) yrs; COPD: 69.3%) were ventilated for >1 hour. Arterial blood gases significantly improved after two hours of NIPPV (mean (standard deviation) pH: 7.33 (0.07) versus 7.28 (7.25-7.31), p 48 hrs of ventilation) after an initial positive response. Conclusions: As results of ten years of clinicalexperience at our UTSIR, NIPPV was shown to be well tolerated, effective in improving arterialblood gases and useful in avoiding intubationin most ARF episodes non-responsive to standard therapy.

Keywords

• Non-invasive ventilation
• respiratory care unit
• endotracheal intubation
• hospital mortality
• chronic obstructive pulmonary disease (COPD)