Noninvasive Ventilation in an Intermediate-Care-Unit
Keywords:
non invasive ventilation, intermediate care unit, chronic obstructive pulmonary diseaseAbstract
Background: Non-Invasive Ventilation (NIV) is a method of alveolar
ventilation, which has been shown to be effi cient and safe in patients
with chronic or acute respiratory insuffi ciency. Our experience with
NIV, in a Medical Intermediate-Care-Unit, over a 2-year period, is presented.
Methods: A retrospective study of 66 patients who were treated
with NIV, in the medical intermediate care unit (MICU) of the Garcia
de Orta Hospital, between January of 2001 and December 2002
was performed. Epidemiological, clinical and laboratory data were analysed.
Results: Of 315 patients admitted to the MICU, 66 (20%) were
ventilated non-invasively. Fifty-three percent were male and the mean
age was 68 years. The main underlying conditions leading to NIV were
Chronic Obstructive Pulmonary Disease (COPD) in 33 patients (50%),
Pneumonia in 12 (18%), Congestive Heart Failure (CHF) in 9 (14%),
Post-Extubation-Syndrome (PES) in 6 (9%), Pickwick Disease in 4
(6%), Kyphoscoliosis and Amyotrophic Lateral Sclerosis (ALS) one
of each. The interface most commonly selected for NVI was the face
mask (98%). After 48 hours of ventilation, signifi cant improvement
of gas exchange was achieved in 61% of patients. Nine patients
deteriorated clinically within this period, of whom, three needed to
be transferred to an intensive care unit for invasive ventilation and
3 patients died. The mean length of stay in the MICU was 8.5 days,
with a mean time of ventilation of 6.4 days ( 8.8 in CHF, 7 in PES, 6
in COPD and 3.8 in Pneumonia). Invasive ventilation was necessary
in 11 patients, 4 with COPD, 3 with pneumonia, 2 with CHF, 1 with
Pickwick disease and 1 with PES. Nine percent of the patients, all
suffering from COPD, continued NIV after discharge on an outpatient
basis. The overall mortality of patients undergoing NIV was 21%.
Conclusion and Discussion: NIV lead to signifi cant improvement in
gas exchange in 61% of patients, within the fi rst 48 hours. Patients
with COPD, CHF and pneumonia had the highest benefi t, the latter
requiring the shortest time of ventilation.
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References
Valença J. Ventilação Não Invasiva em cuidados intensivos. 33º curso de pneumologia para pós-graduados – Doenças obstrutivas do pulmão, Lisboa, 13-15 de Abril de 2000.
Mehta S, Hill N. Noninvasive Ventilation. American Journal of Respiratory and Critical Care Medicine 2001; (163): 540-577.
Shneerson JM, Simonds AK. Noninvasive ventilation for chest wall and neuromuscular disorders. European Respiratory Journal 2002; 20: 480-487.
Clinical Indications for Noninvasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to Resrictive Lung Disease, COPD, and Nocturnal Hypoventilation – A Consensus Conference Report. Chest 1999; 116: 521-534.
G. Christophe G, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G. Noninvasive Ventilation as a Systematic Extubation and weaning Technique in Acute-on-Chronic Respiratory Failure. American Journal of Respiratory and Critical Care Medicine 1999 ;(160): 86-92.
International Consensus Conferences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. American Thoracic Society. American Journal of Respiratory and Critical Care Medicine 2001; (163) 283-291.
Plant P, Owen J, Elliott M. A multicenter randomised controlled trial of the early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. Lancet 2000; 355:1931-1935.
Brochard L, Mancebo J, Wysocky M, etal. Noninvasive positive pressure ventilation via face mask: first line intervention with acute hypercapnic and hypoxemic respiratory failure. Chest 1996; 109: 179-193.
Benditt J. Noninvasive ventilation at the end of life. Respir Care 2000; 45(11): 1376-1381.
Brochard L, Mancebo J, Wysocki M et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995; 333: 817.
Celikel T, Sungur M, Ceyhan B et al. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 1998; 114: 1636-1642.
Ram FS, Lightowler JV, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2003; CD004104.
Carlucci A, Richard JC, Wysocki M et al. Noninvasive versus conventional mechanical ventilation: an epidemiological survey. Am J Respir Crit Care Med 2001; 163: 874-880.
Nava S, Carbone G, DiBattista N et al. Noninvasive ventilation in cardiogenic pulmonary edema. Am J Respir Crit Care Med 2003; 168: 1432.
Liesching T, Kwok H, Hill N. Acute applications of non-invasive positive pressure ventilation. Chest 2003; 124: 699-713.
Confaloniere M, Potena A, Carbone G et al. Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of non-invasive ventilation. Am J Respir Crit Care Med 1999; 160: 1585-1591.
Jolliet P, Abajo B, Pasquina P et al. Non-invasive pressure support ventilation in severe community-acquired pneumonia. Intensive Care Med 2001; 27: 812-821
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