Chest
Clinical Investigations in Critical CareNasal Mask Ventilation in Acute Respiratory Failure: Experience in Elderly Patients
Section snippets
Material and Methods
This study successively included patients admitted to the unit with ARF defined by the combination of severe dyspnea, profound hypoxia in room air or during nasal oxygen therapy, severe hypercapnia with respiratory acidosis, and/or disturbances of consciousness. Endotracheal ventilation was discussed in every case taking into account the following elements: the patient's age, his or her previous physiologic and pathologic condition, the family's opinion, and the previous decisions of other
Results
Thirty patients were included in the study (Tables 1 and 2): 16 women and 14 men with a mean age of 76 years (range, 59 to 93 years). All patients suffered from severe respiratory distress (mean PaO2, 5.85 ± 1.02 kPa; mean PaCO2, 9.27 ± 1.89 kPa; mean pH, 7.28 ± 0.08; mean respiratory rate, 26.68 ± 7.72/min; disturbances of consciousness, 24/30). The simplified acute physiology score (SAPS),18 calculated at the time of inclusion into the study, was 11.4 ± 3.94. Nasal ventilation was selected as
Discussion
Our study confirms the efficacy of NMV in acute respiratory distress, especially in acute decompensations of COPD. This method enabled us to rapidly obtain better blood oxygenation without any initial aggravation of hypercapnia, followed by a reduction in hypercapnia, reflecting an improvement in alveolar hypoventilation within several hours. This resulted in a rapid clinical improvement, particularly in the level of consciousness, in 70 percent of our patients and a favorable respiratory
Conclusion
Intermittent positive pressure mechanical ventilation using a nasal mask therefore appears to be a valuable alternative to ETV in the treatment of ARF, especially in the course of acute decompensations of COPD. Except in the extreme emergency situations in which immediate ETV is required, it may constitute first-line treatment in very elderly subjects in whom ETV may be questionable. In patients with chronic restrictive or obstructive respiratory failure, it may avoid the need for intubation
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