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Non-invasive positive pressure ventilation in the ER.

Patients with respiratory failure are usually intubated and mechanically ventilated. But, some patients with heart failure (HF) or chronic obstructive pulmonary disease (COPD) suffer additional complications from mechanical ventilation such as pneumonia and difficulty in weaning.

Non-invasive positive pressure ventilation (NPPV) includes the modalities of CPAP and BiPAP and may provide benefits for patients with HF and COPD while avoiding the complications associated with mechanical ventilation. And although many patients will recover rapidly while receiving NPPV, some will continue to decompensate and need to be intubated and mechanically ventilated.

In their study, Merlani et al. set out to define the characteristics of patients who did not tolerate NPPV to provide objective criteria for making the decision to discontinue treatment and switch to mechanical ventilation.

After one hour of treatment, the two primary variables that patients who failed NPPV exhibited were acidosis (pH <7.35)>20). These patients were three times more likely to need intubation and mechanical ventilation than those who responded within the first hour of NPPV therapy.

Non-invasive positive pressure ventilation is a safe and effective intervention for patients with an exacerbation of COPD and acute HF. However, if the patient is not responsive to therapy within the first hour, it is unlikely that they will improve without the additional therapy provided by intubation and mechanical ventilation.

From: Merlani, P.G., et al. (2005). Factors associated with failure of non-invasive positive pressure ventilation in the emergency department. Academy of Emergency Medicine, 12: 1206-15.
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Title Annotation:News You Can Use
Publication:Nevada RNformation
Article Type:Brief article
Geographic Code:1USA
Date:May 1, 2008
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