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Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism
Published on: February 14, 2022
Noninvasive positive pressure ventilation in status asthmaticus
G U Meduri1, T R Cook, R E Turner
1Division of Pulmonary and Critical Care Medicine, University of Tennessee, Memphis 38163, USA.
Chest
|September 1, 1996
Summary
Noninvasive positive pressure ventilation (NPPV) effectively treats acute respiratory failure in asthma patients by improving gas exchange and reducing work of breathing. This method is well-tolerated and avoids complications associated with endotracheal intubation.
Area of Science:
- Pulmonary and Respiratory Medicine
- Critical Care Medicine
- Nephrology and Urology
Background:
- Endotracheal intubation in asthmatic patients with acute respiratory failure (ARF) carries high complication rates and increases airway resistance.
- Mask-continuous positive airway pressure (CPAP) in acute asthma reduces airway resistance and work of breathing (WOB) but does not improve gas exchange.
- In COPD with ARF, adding intermittent positive pressure ventilation to mask-CPAP improves WOB and corrects gas exchange.
Purpose of the Study:
- To evaluate the effectiveness of noninvasive positive pressure ventilation (NPPV) as a first-line therapy for hypercapnic ARF in asthma patients.
- To report the medical ICU's experience with NPPV in 17 asthma and ARF episodes over three years.
Main Methods:
- NPPV was administered via a face mask connected to a ventilator (PB-7200).
- Initial settings included CPAP at 4 +/- 2 cm H2O and pressure support ventilation (PSV) at 14 +/- 5 cm H2O, targeting a respiratory rate < 25 breaths/min and tidal volume >= 7 mL/kg.
- PSV was adjusted based on arterial blood gas results.
Main Results:
- NPPV significantly improved pH (7.25 to 7.38) and reduced PaCO2 (65 to 45 mmHg) and respiratory rate (29.1 to 17 breaths/min) within 24 hours.
- Mean peak inspiratory pressure was 18 +/- 5 cm H2O, well below 25 cm H2O.
- NPPV was well tolerated, with only two patients requiring intubation; all patients survived with a mean hospital stay of 5 days.
Conclusions:
- NPPV via face mask is highly effective in correcting gas exchange abnormalities in asthmatic patients with ARF.
- The therapy utilizes low inspiratory pressures (< 25 cm H2O) and appears safe, preserving oral intake and secretion expectoration.
- A randomized study is underway to further define NPPV's role in status asthmaticus.
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