Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: ten-year’s clinical experience of a Respiratory Semi-Intensive Care Unit (VERSIONE IN ITALIANO)

Abstract

BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIV) in selected cases of acute hypercapnic respiratory failure (IRA) in setting with different care levels, clinical practice data about the use of NIV in the “real world” are limited.AimTo report the results of our clinical experience in NIV applied for IRA in the Respiratory Semi-Intensive Care Unit (UTSIR) allocated within the Respiratory Division of Arezzo in the years 1996-2006 in terms of: tolerance, effects upon arterial blood gases, success rate and predictors of failure.MethodsThree hundred filthy of the 1484 patients (23.6%) consecutively admitted for IRA to our RespiratoryDivision during the study period received NIV in addition to standard therapy, according to the pre-defined routinely used criteria.ResultsEight patients (2.3%) did not tolerated NIV becauseof mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartiles) age: 74.0 (68.0-79.3) yrs; COPD: 69.3%) were ventilatedfor >1 hour. Arterial blood gases significantlyimproved after two hours of NIV (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.ConclusionsAs results of our ten-year’s clinical experience performed in a UTSIR, NIV is confirmed to be well tolerated, effective in improving arterial blood gases and useful in avoiding intubation in most IRA episodes non-responder to standard therapy.

Keywords

• Non-invasive positive pressure ventilation
• respiratory semi-intensive care unit
• acute respiratory failure
• respiratory ward
• endotracheal intubation
• hospital mortality
• COPD