The use of Bi-level positive pressure ventilation in the treatment of acute respiratory failure within the emergency department

The roles of noninvasive positive pressure ventilation (NIPPV) as a treatment modality for patients presenting with acute respiratory failure (ARF) to the emergency department (ED) have not been clearly identified. The major advantages of NIPPV are avoiding patient's discomforts and complications relating to endotracheal intubation and mechanical ventilation. This review is to explore the current evidence on the effectiveness of NIPPV in various subgroups of patients with ARF. The rationales, advantages, complications and contraindications in the usage of NIPPV will also be discussed. There is robust evidence to support the use of NIPPV in severe acute exacerbation of chronic obstructive airway disease (COAD). A modest amount of favourable evidence supports the use of Continuous Positive Airway Pressure (CPAP) in cardiogenic pulmonary oedema, although the potential for harm has not been excluded. There exists no solid evidence supporting the use of NIPPV in asthma and pneumonia. Early institution of NIPPV in the ED is appropriate, feasible, likely to be beneficial and without major complications. Further good quality studies to evaluate the roles of NIPPV for ARF in the ED setting are needed to define which groups of patients can gain most benefit from this type of treatment.

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S76 Non-invasive positive pressure ventilation to reduce childhood mortality from acute respiratory failure in rural ghana

Thorax ◽

10.1136/thoraxjnl-2013-204457.83 ◽

2013 ◽

Vol 68 (Suppl 3) ◽

pp. A41.1-A41

Author(s):

RE Balfour-Lynn ◽

G Marsh ◽

D Gorayi ◽

E Elahi ◽

JM LaRovere

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Positive Pressure Ventilation ◽

Childhood Mortality ◽

Positive Pressure ◽

Non Invasive ◽

Rural Ghana ◽

Reduce Childhood Mortality

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Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽

10.1093/qjmed/hcab086.039 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed N Al Shafi'i ◽

Doaa M. Kamal El-din ◽

Mohammed A. Abdulnaiem Ismaiel ◽

Hesham M Abotiba

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Positive Pressure Ventilation ◽

Invasive Mechanical Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Positive Pressure ◽

Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

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