The Science Journal of the American Association for Respiratory Care

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.

OF-01-180

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