Citation Information :
Nizami MI, Sharma A, Jayaram K. Feasibility of Early Noninvasive Ventilation Strategy for Patients with Acute Onset Shortness of Breath in Emergency Department — A Prospective Interventional Study. Indian J Crit Care Med 2019; 23 (9):400-404.
Introduction: Noninvasive ventilation (NIV) has revolutionized the initial respiratory support provided to a patient in respiratory distress presenting to emergency department. Standardization of NIV practices and safety has always been a matter of concern and debate in emergency medicine. In this study, we tried to assess the clinical outcome of NIV in respiratory failures of varied etiologies.
Materials and methods: This study was conducted from August 2017 to August 2018 at our emergency department which is a tertiary care teaching institute. All patients presenting to the ED with shortness of breath were screened for acute respiratory failure and enrolled after confirming the inclusion criteria.
Results: Out of the 236 patients presenting with acute respiratory failure, 182 fulfilled the study criteria. However, 154 patients with a mean age of 55.19 + 16.73 years were enrolled in the study. Bilevel PAP was initiated in 103 patients whereas 51 patients received CPAP. 115 (74.67%) NIV trials were successful whereas 36 (23.37%) patients had to be intubated. 32 patients died among the study group among which 3 had not consented for intubation. The in-hospital mortality has been 20.77% whereas the percentage of NIV failure with consequent intubation was 25.32%.
Conclusion: In conclusion, our study shows that NIV is not only safe and efficacious but also significantly brings down the requirement of endotracheal intubations and its complications provided proper patient selection and close monitoring is assured.
Kramer N, Meyer TJ, Meharg J, et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995;151:1799–1806.
Martin TJ, Hovis JD, Costantino JP, et al. A randomized prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 2000;161:807–813.
Antonelli M, Conti G, Rocco M, et al. A comparison of non-invasive positive pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 1998;339:429–435.
Declaux C, L’Here Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivery by a face mask: a randomised controlled trial. JAMA 2000;284:2352–2360.
Peter JV, Moran JL, Phillips-Hughes J, et al. Noninvasive ventilation in acute respiratory failure – A meta-analysis update. Crit Care Med 2002;30:555–562.
Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and metaanalysis. BMJ 2003;326:185–187.
Vitacca M, Clini E, Rubini F et al. Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory insufficiency: short and long-term prognosis. Intensive Care Med 1996;22:94–100.
Putinati S, Ballerin L, Piattella M, et al. Is it possible to predict the success of noninvasive positive pressure ventilation in acute respiratory insufficiency due to COPD? Respir Med 2000;94:997–1001.
Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxaemic respiratory insufficiency: a multicenter study. Intensive Care Med 2001;27(11):1718–1728.
Poponick JM, Renston JP, Bennett RP, et al. Use of a ventilatory support system (BiPAP) for acute respiratory insufficiency in the emergency department. Chest 1999;116:166–171.
Merlani PG, Pasquina P, Granier JM, et al. Factors associated with failure of noninvasive positive pressure ventilation in the emergency department. Acad Emerg Med 2005;12:1206–1215.
Elliot MW, Confalonieri M, Nava S. Where to perform noninvasive ventilation? Eur Respir J 2002;19:1159–1166.
Nava S, Evangelisti I, Rampolla C, et al. Human and financial costs of noninvasive ventilation in patients affected by COPD and acute respiratory failure. Chest 1997;111:1631–1638.
Bellone A, Vettorello M, Monari A, et al. Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema. Intensive Care Med 2005;31:807–811.
Wysocki M, Antonelli M. Noninvasive mechanical ventilation in acute hypoxaemic respiratory insufficiency. Eur Respir Mon 2001;16:49–66.
Park M, Sangean MC, Volpe Mde S, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med. 2004;32 (12):2546–2548.
Jolliet P, Abajo B, Pasquina P, et al. Non-invasive pressure support ventilation in severe community acquired pneumonia. Intensive Care Med 2001;27(5):812–821.
American Thoracic Society. International consensus conferences in Intensive care medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 2001;163:283–291.
Paolo Groff, Fabrizio Giostra, Stefania Ansaloni, et al. Use of non-invasive mechanical ventilation in the Emergency Department, clinical outcomes and correlates of failure. Ital J Public Health 2008; 5: 198–211.
Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004;3.
Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005;294:3124–3130.
Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 2003;168:1438–1444.
Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 2007;35:18–25.