The use of noninvasive pressure support ventilation for severe respiratory insufficiency due to pulmonary oedema

Objective: Experimental use of noninvasive pressure support ventilation (NIPSV) in patients with severe pulmonary oedema who would have been intubated if noninvasive ventilation were not available. Design: Open, prospective, within patients non comparative study. Setting: Internal intensive care unit (11 beds) at a university hospital. Patients: 29 patients with severe respiratory distress and confirmed pulmonary oedema. Interventions: NIPSV was applied via a tight fitting face mask delivering between 13 and 24 cmH(2)O inspiratory airway pressure and 2 to 8 cmH(2)O expiratory airway pressure. Measurements and results: One patient required endotracheal intubation. Mean plethysmographic oxygen saturation rose significantly within 30 min from 73.8 +/- 11 to 90.3 +/- 5%, while the oxygen supply was reduced from 7.3 +/- 3.7 to 5.1 +/- 3 l/min. Mean pH increased significantly (p < 0.01) from 7.22 +/- 0.1 before NIPSV to 7.31 +/- 0.07 after 60 min of NIPSV. Partial pressure of carbon dioxide was 62 +/- 18.5 mmHg but decreased significantly within 60 min to 48.4 +/- 11.5 mmHg. Heart rate and blood pressure stabilised continuously during the observation time. Mean duration of NIPSV was 6 h 9 min (range 60 min to 24 h). There were no serious side effects. Four patients died from underlying diseases between 1 and 28 days after NIPSV. Conclusion: NIPSV is a highly effective technique with which to treat patients with severe cardiogenic pulmonary oedema.