Non Invasive Mechanical Ventilation in Acute Respiratory Failure
khalaf, A., Abouelella, A., Mohammadien, H. (2017). Non Invasive Mechanical Ventilation in Acute Respiratory Failure. EKB Journal Management System, 21(1), 47-62. doi: 10.21608/smj.2017.39011
Asmaa khalaf; Azza Mahmoud Abouelella; Hamdy Mohammadien. "Non Invasive Mechanical Ventilation in Acute Respiratory Failure". EKB Journal Management System, 21, 1, 2017, 47-62. doi: 10.21608/smj.2017.39011
khalaf, A., Abouelella, A., Mohammadien, H. (2017). 'Non Invasive Mechanical Ventilation in Acute Respiratory Failure', EKB Journal Management System, 21(1), pp. 47-62. doi: 10.21608/smj.2017.39011
khalaf, A., Abouelella, A., Mohammadien, H. Non Invasive Mechanical Ventilation in Acute Respiratory Failure. EKB Journal Management System, 2017; 21(1): 47-62. doi: 10.21608/smj.2017.39011

Non Invasive Mechanical Ventilation in Acute Respiratory Failure

Sohag Medical Journal
Article 6, Volume 21, Issue 1, January 2017, Page 47-62  XML PDF (165.46 K)
Document Type: Original Article
DOI: 10.21608/smj.2017.39011
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Authors
Asmaa khalaf; Azza Mahmoud Abouelella; Hamdy Mohammadien
Department of Thoracic Diseases, Faculty of medicine, Sohag University
Abstract
Objectives : Acute respiratory failure is a common clinical condition encountered in emergency department and intensive care units (ICU). The use of NIV during acute respiratory failure (ARF) has increased since the late 1990s for all diagnoses, including patients with and without chronic obstructive pulmonary disease (COPD). The use of NIV is associated with reduced tracheal intubation, duration of hospitalization, and mortality.
Aim of the work: To evaluates the effectiveness of Non invasive ventilation in the management of acute hypercapnic respiratory failure of different aetiologies as acute exacerbation of COPD, and acute hypoxemic respiratory failure.
Design of study:  Prospective, Observational, Single-center study.
Patients  and Methods: 103 patients with acute respiratory failure (ARF) were admitted to Respiratory Intensive Care Unit (RICU) of Chest Department at Assuit University Hospital and received non invasive ventilation, in all patients demographic , clinical and functional parameters were recorded including the cause of acute respiratory failure . NIV success was defined as clinical and gasometric improvement and discharge to regular ward, while need of endotrachial intubation was considered NIV failure.
 Results:  one hundred and three patients with mean age 59.1 years were included in the study,62 (60%) were males and 41(40%) were females, Baseline pH, PaCO2 and PaO2 were 7.51±0.09, 72±21.63and 59.41±20.34 mmHg respectively.
The success rate with NIPPV was 69%, with 71of 103 patients weaned successfully. Significant improvements were observed at 2 hour,24-48hrs following institution of NIPPV in pH (7.34±0.08, P < 0.02), PaCO2 (62.87±17.94, P < 0.002) and PaO2(74.30±14.45 P < 0.001).These improvements maintained (within 24 hrs) postweaning from the ventilator, pH 7.39±0.04, PaCO2 56.76±10.18, PaO2 73.28±10.04 ( P < 0.001).
Duration of mechanical ventilation , length of ICU stay were significantly longer in NIV failure group (p<0.0001). , the complications and death were significantly higher in NIV failure group (p<0.00001),(p<0.0001).
Serum albumin level was significantly lower in the NIV failure group (p<0.01).
Conclusion: The use of NIV in patients presenting with ARF of diverse etiology
has shown to be effective in the improvement of clinical and gasometric parameters, in preventing endotracheal intubation, and improving overall survival
Keywords
Acute Respiratory Failure; Noninvasive ventilation; COPD
Supplementary Files
References
  1. Palange P., Simonds A.K.: ERS Handbook of Respiratory Medicine-Definition of Respiratory Failure, 2010 .
  2. Cartin-Ceba R, Kojicic M, Li G.: Epidemiology of critical care syndromes, organ failures, and life-support interventions in a suburban US community. Chest. 2011;140(6):1447-55.
  3. Demoule A, Chevret S, Carlucci A.: Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med 2016 ;42:82–92.
  4. Nava S, Hill N .: Non-invasive ventilation in acute respiratory failure,Lancet 2009; 374(9685):250–259.
  5. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A,: Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333(13):817–822.
  6. Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. Jul 10 2008; 359(2):142-51
  7. Demoule A, Chevret S, Carlucci A et al (2016) Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophonecountries. Intensive Care Med 42:82–92
  8. 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 2004;(1):CD004104.
  9. Mohamed A. Zamzam , Amal A. Abd El Aziz , Maha Y. Elhefnawy , Nagia A. Shaheen :Study of the characteristics and outcomes of patients on mechanical ventilation in the intensive care unit of EL-Mahalla Chest Hospital, Egyptian Journal of Chest Diseases and Tuberculosis 2015; 64, 693–701.
  10. 4. Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: A metaanalysis. Lancet 2006;367:1155-63.
  11. Peter JV, Moran JL, Phillips-Hughes J, Warn D.: Non-invasive ventilation in acute respiratory failure: a meta-analysis update.Crit Care Med 2002;30:555–62.
  12. Plant PK, Owen JL, Elliott MW. Early use of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: A multicentre randomized controlled trial. Lancet 2000;355:1931-5.
  13. Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe ME, Rogers RM, et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 2000;161:807-13.
  14. Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature, Ann Intern Med. 2003 ;138(11):861-70.
  15. Khilnani GC, Saikia N, Sharma SK, Pande JN, Malhotra OP. EfÞ cacy of noninvasive pressure ventilation for the management of COPD with acute or acute on chronic respiratory failure: A randomized controlled trial. Am J Respir Crit Care 2002;165:A387
  16. Lightowler J.V., Wedjicha J.A., Elliott M.W.: Noninvasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta analysis, BMJ 326 2003; 185–187.
  17. Keenan SP, Sinuff T, Cook DJ, Hill NS.: Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med. 2004; 32:2516–23.
  18. Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G,Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A.: A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation, Eur Respir J 2005; 25:348–355.
  19. Diaz GG, Alcaraz AC, Talavera JC,: Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure, Chest. 2005; Mar. 127(3):952-60. 
  20. Vitacca M, Clini E, Porta R, Foglio K, Ambrosino N.: Acute exacerbations in patients with COPD: Predictors of need for mechanical ventilation. Eur Respir J 1996;9:1487-93.
  21. Boosalis MG, Ott L, Levine AS, Slag MF, Morley JE, Young B,: Relationship of visceral proteins to nutritional status in chronic and acute stress. Crit Care Med 1989;17:741-7.
  22. Girou E, Schortgen F, Delclaux C.: Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. J Am Med Assoc 2000; 284: 2361–2370. 
  23. Gay PC. Complications of noninvasive ventilation in acute care. Respir Care 2009; 54: 246–57.
  24. Singh VK, Khanna P, Rao BK, Sharma SC, Gupta R.: Outcome predictors for noninvasive positive pressure ventilation in acute respiratory failure. J Assoc Physicians India 2006; 54: 361-
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