Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation

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

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Objective: To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation. Design: Case series. Setting: Medical intensive care units (ICUs) in a university health science center. Patients: Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs. Intervention: Mechanical ventilation was delivered via a face mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of <25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. Measurements and Main Results: Mechanical ventilation via face mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via face mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via face mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication. Conclusions: We conclude that mechanical ventilation via face mask offers an effective, comfortable, and dignified method of supporting patients with end- stage disease and acute respiratory failure.

Original languageEnglish (US)
Pages (from-to)1584-1590
Number of pages7
JournalCritical Care Medicine
Volume22
Issue number10
DOIs
StatePublished - Jan 1 1994

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Noninvasive Ventilation
Intratracheal Intubation
Masks
Artificial Respiration
Respiratory Insufficiency
Intensive Care Units
Gases
Respiratory Acidosis
Terminally Ill
Continuous Positive Airway Pressure
Tidal Volume
Acute Disease
Mechanical Ventilators
Respiratory Rate
Dyspnea
Ventilation

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. / Meduri, Gianfranco; Fox, R. C.; Abou-Shala, N.; Leeper, K. V.; Wunderink, R. G.

In: Critical Care Medicine, Vol. 22, No. 10, 01.01.1994, p. 1584-1590.

Research output: Contribution to journalArticle

Meduri, Gianfranco ; Fox, R. C. ; Abou-Shala, N. ; Leeper, K. V. ; Wunderink, R. G. / Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. In: Critical Care Medicine. 1994 ; Vol. 22, No. 10. pp. 1584-1590.
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