Abstract:

Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease (COPD), Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS). NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5%) met primary endpoint (NIV failure): 11 Pts (17%) needed ETI (5ALI/ARDS p < 0,0001, 6COPD 16,6%), 1 Patient (1,5%) died (Pneumonia). No Pts with ACPE failed (p = 0,0027). Secondary endpoints: significant improvement in Respiratory Rate (RR), Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff’s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting. Federico Lari, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto Novella Scandellari, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto Ferdinando De Maria, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto Virna Zecchi, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto Gianpaolo Bragagni, Medicina Interna, Azienda USL di Bologna, Ospedale SS Salvatore di San Giovanni in Persiceto Fabrizio Giostra, Medicina d’Urgenza, Azienda Ospedaliero Universitaria di Bologna, Policlinico S.Orsola Malpighi Nicola DiBattista, Medicina d’Urgenza, Azienda USL di Ravenna Ospedale per gli Infermi di Faenza Lari, F., Scandellari, N., De Maria, F., Zecchi, V., Bragagni, G., Giostra, F., & DiBattista, N. (2009). Non-invasive mechanic ventilation in treating acute respiratory failure. Emergency Care Journal, 5(6), 8–20. https://doi.org/10.4081/ecj.2009.6.8 More Citation Formats ACM ABNT Chicago Harvard MLA Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.

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