2001 OPEN FORUM Abstracts
Noninvasive Positive pressure ventilation for "do not intubate" patients with acute respiratory failure: A prospective observational study.
Neila Altobelli,RRT; Guilherme Schettino, MD; Purris Willians, RRT; Jack Walsh, RRT; KhaledSedeek, MD; Klaudiusz Suchodolski, MD; Dean Hess PhD RRT; Robert Kacmarek, PhDRRT. Massachusetts General Hospital and Harvard Medical School, Boston MA.
Background: Noninvasivepositive pressure ventilation (NPPV) has been usedto treat patients with reversible causes of acute respiratory failure (ARF),or simply as a comfort maneuver, in terminal patients who refused endotrachealintubation (DNI). However few data is available about patient selection criteriaand hospital discharge rate for these patients.
Objective: Toevaluate the outcome of DNI patients when submitted to NPPV to treat acute oracute on chronic respiratory failure of different etiologies.
Design: A prospectiveobservational study.
Setting: An800-bed tertiary university hospital.
Method: Thedemographic, clinical, physiological, laboratory and hospital outcome data,as well as the ventilatory settings, of all DNI patients with ARF treated withNPPV were recorded on a daily basis.
Results: FromJanuary to April 2001, NPPV was applied in 46 DNI patients (32 female) originallylocated in the emergency room (14%), intensive care units (18%) and generalmedical/surgical units (68%). In 56 % of the cases NPPV was applied for <24hs and in 22% for a period between 1 to 3 days. PS/PEEP (80%) and CPAP (20%)were the utilized modes. The hospital survival rate was greater for patientswith acute exacerbation of chronic pulmonary disease (9/13 cases) when comparedto hypoxemic respiratory failure (4/20) (p=0.02). Cardiogenic pulmonary edema(11 cases) and post-extubation failure (2 cases) had a survival rate of 45 and0% percent respectively. The hospital mortality was higher in the oncologicalpatients (14/16 [87.5%]) when compared with the non-oncological (14/30 [47%])patients (p< 0.01). Hypoxemic respiratory failure (12/16 [all died]) wasthe leading cause of ARF in the oncological.
The baseline data of the non-oncologicalpatients are present in the table.
Conclusion: The use of NPPVshould be encouraged in non-oncological DNI patients with reversible causesof ARF, particularly in those with acute exacerbation of chronic pulmonary disease.The outcome of oncological DNI patients with hypoxemicARF treated with NPPV is extremely poor.