Property | Value |
Name | The Parameters to be considered before putting the patient on non-invasive positive pressure ventilation (Nippv) in acute respiratory failure |
Description | Research article:- Pulmonology and Critical Care Rakesh K Gupta* *Assistant Professor, Department of Pulmonology and Critical Care, King Fahd Hospital of University , University of Dammam, Kingdom of Saudi Arabia.
Abstract: Background: In recent years non-invasive ventilator modalities have been developed to improve alveolar ventilation and oxygenation with-out the need for an artificial airway. It is found to be an effective modality for the treatment of hypercapnic as well as hypoxic respiratory failure. In some patients however noninvasive ventilation is inadequate and invasive ventilation cannot be avoided. Failure of initial trial of NIPPV may lead to a delay in intubation and associated with significant increase in mortality. Objectives: To find the base line parameters associated with failure of NIPPV so that individual could be identified who are likely to fail to respond to NIPPV either before or shortly after a trial of therapy. Methods: Prospective observational study was conducted including hypoxic and hypercapnic respiratory failure and put on NIPPV. The patients ECG, oxygen saturation, blood pressure and respiratory rate were continuously monitored. Arterial blood gas level measured on admission, 1, 4, 12, 36 hours after starting NIPPV. Result: It was observed that among the hypoxemic patients unsuccessful group had significantly higher heart rate (128±9.98 Vs 115±14.4, p = 0.43) than successfully treated group. ADL score was also found to be significantly low in failure group (1.50±0.54 Vs 2.35±0.67, p = 0.009) in comparison to success group. After 1 hr of administration of NIPPV respiratory rate (27±4.73) and PaO2 (94.2±21.6) in success group improved significantly. In hypercapnic group baseline heart rate (134±8.36 Vs 105±12.3) and respiratory rate (37.4±3.95 Vs 33.5 ±2.32) was significantly higher in failure patients as compared to successful ones. After 1hr of NIPPV trial pH, HR and RR improve significantly in success group as compared to failure group 7.36±0.04 Vs 7.30±7.99, 93±15.1 Vs 135±7.99, 27.9±5.83 Vs 37.1±3.98 respectively. Conclusion: NIPPV may be useful for avoiding intubation in patients with acute respiratory failure but data available at the time of initiation of NIPPV and after a short period can predict the likelihood of success or failure. So that any delay in intubation can be avoided which itself is associated with significant mortality. |
Filename | Rakesh K Gupta.(218-222).pdf |
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Creator | admin |
Created On: | 12/03/2012 00:00 |
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Last updated on | 12/28/2012 05:59 |
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