The use of noninvasive pressure support ventilation for severe respiratory insufficiency due to pulmonary oedema.

Abstract

Experimental use of noninvasive pressure support ventilation (NIPSV) in patients with severe pulmonary oedema who would have been intubated if noninvasive ventilation were not available. Open, prospective, within patients non comparative study. Internal intensive care unit (11 beds) at a university hospital. 29 patients with severe respiratory distress and confirmed pulmonary oedema. NIPSV was applied via a tight fitting face mask delivering between 13 and 24 cm H2O inspiratory airway pressure and 2 to 8 cm H2O expiratory airway pressure. One patient required endotracheal intubation. Mean plethysmographic oxygen saturation rose significantly within 30 min from 73.8+/-11 to 90.3+/-5%, while the oxygen supply was reduced from 7.3+/-3.7 to 5.1+/-3 l/min. Mean pH increased significantly (p<0.01) from 7.22+/-0.1 before NIPSV to 7.31+/-0.07 after 60 min of NIPSV. Partial pressure of carbon dioxide was 62+/-18.5 mmHg but decreased significantly within 60 min to 48.4+/-11.5 mm Hg. Heart rate and-blood pressure stabilised continuously during the observation time. Mean duration of NIPSV was 6 h 9 min (range 60 min to 24 h). There were no serious side effects. Four patients died from underlying diseases between 1 and 28 days after NIPSV. NIPSV is a highly effective technique with which to treat patients with severe cardiogenic pulmonary oedema.