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[Noninvasive pressure support ventilation (NIPSV) as therapy for severe respiratory insufficiency due to pulmonary
1Klinik für Kardiologie, Angiologie und Pneumologie, Otto-von-Guericke Universität, Magdeburg.
Objective:
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.
Design:
Open, prospective, within patients non comparative study.
Setting:
Internal intensive care unit (11 beds) at a university hospital.
Patients:
29 patients with severe respiratory distress and confirmed pulmonary oedema.
Interventions:
NIPSV was applied via a tight fitting face mask delivering between 13 and 24 cm H2O inspiratory airway pressure and between 2 and 8 cm H2O expiratory airway pressure.
Measurements And Results:
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 +/- 0.01 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 established continuously during observation time. Mean duration of NIPSV was 6 h 9 min (range 120 min to 24 h). There were no serious side effects. Four patients died from underlying diseases between 1 and 28 days after NIPSV.
Conclusion:
NIPSV is a highly effective technique with which to treat patients with severe cardiogenic pulmonary oedema.