[Inspiratory pressure support via facial mask in acute respiratory insufficiency]

A patient in acute respiratory failure (Murray score 2.0) caused by pneumonia in the remaining lung 4 days after left-sided pneumonectomy was successfully treated with non-invasive pressure support by face mask. Non-invasive ventilation was chosen to keep the time of ventilating as short as possible, to achieve minimum pressure within the airways, and to retain natural defense and clearance mechanisms. Inspiratory pressure support was added to reduce increased work of breathing, improve ventilatory mechanics and gas exchange. Also, intrinsic PEEP was counterbalanced by external PEEP of 5 cmH2O to reduce work of breathing. Inspiratory pressure support of 15 cmH2O reduced respiratory rate to less than 30 breaths/min, improved paO2 and reduced elevated paCO2 towards normal within 3 hours. Duration of the non-invasive ventilation was 45 hours. There were no complications.