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Clinical Investigations in Critical Care: NIPPVHuman and Financial Costs of Noninvasive Mechanical Ventilation in Patients Affected by COPD and Acute Respiratory Failure
Section snippets
Materials and Methods
This prospective study, approved by the Local Institutional Ethics Committee, was performed between June 1995 and March 1996 at the RICU of Montescano Rehabilitation Center. The patient/staff ratio was and is currently 3:1 for MDs, 2:1 for Ns, and 3:1 for RTs. Sixteen consecutive COPD patients requiring mechanical ventilation were studied. The precipitating cause of acute respiratory failure was respiratory tract infection, without radiologic evidence of pneumonia. All the patients were also in
Results
As illustrated in Table 2, the institution of both NIMV and InMV improved the arterial blood gas values of the patients by hospital discharge, although one patient from each group died before the weaning. The group A patient died of pneumonia on day 9. Multiple organ failure was the cause of death for the group B patient on day 7.
The upper part of Figure 1 illustrates the total Ns workload per patient in the first 48 h of MV. No significant differences were observed in the time of assistance
Discussion
There is now clear evidence that in “selected” populations of COPD patients, NIMV may replace endotracheal intubation during an episode of acute respiratory failure.6, 7 Besides the well-known side effects of NIMV, such as skin abrasion, mask leaks, and gastric distention,2 one of the major limitations to the use of this mode of ventilation is that it may be overly time-consuming for hospital personnel. This concern is mainly founded on an uncontrolled study performed in three patients with
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N Engl J Med
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