Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure

Gianfranco Meduri, N. Abou-Shala, R. C. Fox, C. B. Jones, K. V. Leeper, R. G. Wunderink

Research output: Contribution to journalArticle

240 Citations (Scopus)

Abstract

Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a face mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in PCO2 (>16 percent decrease) and in pH (from <7.30 to >7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the face mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency.

Original languageEnglish (US)
Pages (from-to)445-454
Number of pages10
JournalChest
Volume100
Issue number2
DOIs
StatePublished - Jan 1 1991

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Masks
Artificial Respiration
Respiratory Insufficiency
Gases
Intermittent Positive-Pressure Ventilation
Intratracheal Intubation
Tidal Volume
Apnea
Hypnotics and Sedatives
Intubation
Necrosis

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Meduri, G., Abou-Shala, N., Fox, R. C., Jones, C. B., Leeper, K. V., & Wunderink, R. G. (1991). Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest, 100(2), 445-454. https://doi.org/10.1378/chest.100.2.445

Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. / Meduri, Gianfranco; Abou-Shala, N.; Fox, R. C.; Jones, C. B.; Leeper, K. V.; Wunderink, R. G.

In: Chest, Vol. 100, No. 2, 01.01.1991, p. 445-454.

Research output: Contribution to journalArticle

Meduri, G, Abou-Shala, N, Fox, RC, Jones, CB, Leeper, KV & Wunderink, RG 1991, 'Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure', Chest, vol. 100, no. 2, pp. 445-454. https://doi.org/10.1378/chest.100.2.445
Meduri, Gianfranco ; Abou-Shala, N. ; Fox, R. C. ; Jones, C. B. ; Leeper, K. V. ; Wunderink, R. G. / Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. In: Chest. 1991 ; Vol. 100, No. 2. pp. 445-454.
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