NONINVASIVE NASAL MASK VENTILATION FOR ACUTE RESPIRATORY-FAILURE - INSTITUTION OF A NEW THERAPEUTIC TECHNOLOGY FOR ROUTINE USE

Objective: We successfully implemented the delivery of noninvasive mechanical ventilation for patients with acute respiratory failure, a previously controversial use bf this technique, using a simplified ventilator (BiPAP) with nasal mask. Pilot work showed this mode of support to be effective when administered by the members of a research team, and in the current study we were able to transfer this responsibility to usual care providers. Setting: Almost 90 percent of the patients in this study were in either the 16-bed medical or 31-bed surgical intensive care units at our hospital. Subjects: One hundred ten hemodynamically stable patients with acute respiratory failure being considered for intubation and mechanical ventilation participated in this study. Eighty percent were surgical patients, most of whom had hypercapnic failure. Intervention: Patients were administered noninvasive ventilatory support using a ventilatory support system (BiPAP) applied with a nasal mask. This intervention was administered by a research team in the initial 31 patients (special care, phase 1). The administration was transferred to usual care personnel in the next 45 patients (transition, phase 2). Usual care personnel almost exclusively administered care in the final 54 patients (usual care, phase 3). Results: Withdrawal of ventilatory support for greater than 48 h (successful outcome) was about the same during usual care (phase 3, 80 percent) as it was during special care (phase 1, 76 percent).