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Clinical Investigations in Critical CareNoninvasive Face Mask Mechanical Ventilation in Patients with Acute Hypercapnic Respiratory Failure
Section snippets
METHODS and MATERIALS
The study was conducted at the University of Tennessee Health Science Center in Memphis from February 1989 to March 1990. The protocol was approved by the institutional review boards of both the University of Tennessee and the VA Medical Center, Memphis.
Diagnostic criteria for hypercapnic respiratory failure included all of the following: (1) severe dyspnea at rest; (2) respiratory rate (RR) >25 breaths per minute; (3) use of accessory muscles of respiration (AMR) or paradoxical abdominal
Hypercapnic Respiratory Failure Group
Eleven patients (patients 1 to 11), eight men and three women, met all criteria for hypercapnic respiratory failure. Their mean age was 61 years (range, 29 to 75 years). Seven patients had severe COPD (mean FEV1, 900 ml) exacerbated by bronchospasm in five, pneumonia in one, and laryngospasm and bronchospasm after extubation in one. One patient had end-stage renal disease with congestive heart failure and pulmonary fibrosis. One had fibrothorax and two had status asthmaticus (Table 1). Two
DISCUSSION
Inspiratory muscle fatigue is thought to be the final common pathway that causes ventilatory failure in patients with COPD.8 Fatigue occurs when the balance between mechanical impedance and muscle power is tipped in favor of impedance against which the respiratory muscles must work.9 The additional workload is caused most frequently by an increase in airway resistance (bronchospasm, secretions) and less commonly by a reduction in compliance (congestive heart failure, pneumonia). Patients
CONCLUSIONS
Whereas most patients improved with FMMV, the response to treatment and duration of MV could not be predicted by the severity of the underlying lung disease (FEV1) or by the ABG values (Pco2, pH) obtained before initiating ventilation. An improvement in Pco2 and in pH after the first hour of FMMV accurately identified those patients who could be successfully ventilated by this means and who would require short-term ventilatory support (mean, 26 h of FMMV vs 323 h of MV with ETI). The face mask
ACKNOWLEDGMENTS
The investigators wish to thank Dr Dominique Robert (Hôpital de la Croix Rousse, Lyon, France) for having initially generated interest and enthusiasm about this alternative mode of ventilatory support, Dr Elizabeth Tolley for statistical analysis, all of the respiratory therapists who have collaborated on this study, Vicky Franke for secretarial assistance, Dr John P. Griffin for helpful suggestions, and Dr D. Armbruster for editorial review.
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Manuscript received August 29; revision accepted December 14.