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Noninvasive ventilation: experience at a community teaching hospital
F Alsous1, Y Amoateng-Adjepong, C A Manthous
1Pulmonary and Critical Care Division, Bridgeport Hospital, CT 06610, USA.
Intensive Care Medicine
|July 13, 1999
Summary
Bilevel positive airway pressure (BiPAP) effectively treated respiratory failure in a community hospital, with higher success rates for hypercapnic than hypoxemic cases. BiPAP failure increased mortality risk, but it also aided post-extubation respiratory support.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Respiratory Therapy
Background:
- Respiratory failure (RF) necessitates timely and effective interventions.
- Noninvasive positive pressure ventilation, specifically bilevel positive airway pressure (BiPAP), offers a potential treatment modality.
Purpose of the Study:
- To evaluate the hospital's experience and outcomes using BiPAP for patients with respiratory failure.
- To assess BiPAP efficacy across different etiologies of RF, including hypoxemic and hypercapnic.
- To determine the impact of BiPAP on mortality and resource utilization.
Main Methods:
- Retrospective observational study conducted at a 300-bed community teaching hospital.
- Analysis of medical records for patients receiving BiPAP for RF between January 1994 and December 1996.
- Inclusion of physiologic and outcome variables, with BiPAP success defined as avoidance of invasive ventilation.
Main Results:
- BiPAP was applied to 80 patients with a mean age of 71.5 years.
- Success was achieved in 47 of 75 classifiable cases (62.7%), with all survivors living and 18 of 28 failures dying.
- BiPAP demonstrated higher success rates in acute hypercapnic RF (20/25) compared to hypoxemic RF (15/31), with a significantly greater risk of failure in hypoxemic patients (RR=2.6).
Conclusions:
- BiPAP is a highly effective treatment for selected RF patients in a community teaching hospital setting.
- Patients with hypercapnic RF exhibit superior outcomes compared to those with hypoxemic RF.
- BiPAP failure is linked to increased in-hospital mortality, but successful use can also support post-extubation RF.