The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

EVALUATION OF INTERVENTION WITH NPPV IN PATIENTS WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE

Jack Edge RRT, Zach Frazier RRT, Terrence Coulter M.D., CoxHealth, Respiratory Care, Springfield, MO.

Background: Acute hypoxemic respiratory failure has been shown to be less responsive to NPPV than hypercapneic respiratory failure. We wanted to determine whether an early and aggressive intervention with NPPV could provide good patient outcomes.

Method: We reviewed all NPPV set-ups (n=295) from Dec 2003-Feb 2004 and classified patients as having either acute hypoxemic respiratory failure (n=85), acute hypercapneic respiratory failure (n=174), or meeting our exclusion criteria (n=36). Acute hypoxemic respiratory failure was determined prior to NPPV initiation and defined as having a P/F < 200 or SpO2≤ 90% on a FIO2 ≥ 0.50, and a PaCO2 ≤ 45 mmHg. Patients were excluded if they had IPPV or CPR prior to NPPV, had a tracheostomy, or had recent facial, esophageal, or cranial trauma/surgery. NPPV settings were detemined by the respiratory therapist at the bedside using our NPPV protocol, and quickly titrated up to an IPAP 25 cm H2O / EPAP 15 cm H2O as needed.

Results: During the period of Dec 2003-Feb 2004, we had 295 NPPV set-ups on 256 patients. 85 patients met our criteria for Acute Hypoxemic Respiratory Failure with the absence of hypercapnea, and met none of the other exclusion criteria. Four subsets of patients were identified: pneumonia (n=38), cardiogenic pulmonary edema (n=26), ARDS (n=16), and other (n=5). Table 1 shows the results of our data for each of these categories.

Patient types # Pts NPPV Hrs Intub. IPPV Hrs Hosp Mort. Unit LOS Day Hosp LOS Day
Pneumonia 38 46.5 (2-212) 4 (11%) 161 5 (13%) 4.5 13.5
Cardio edema 26 30.5 (1-138) 5 (19%) 53 4 (15%) 3.3 12
ARDS 16 45.7 (2-181) 11 (69%) 110 11 (69%) 6.2 12.6
Other 5 50 (1-98) 0 (0%) 0 2 (40%) 1.8 11.8

Conclusions: Early and aggressive intervention with NPPV resulted in mortality and intubation rates of less than 20% for pneumonia and cardiogenic pulmonary edema patients. The high intubation and mortality rates seen with our ARDS patients indicates caution with the initial use of NPPV in these patients.

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