Noninvasive positive pressure ventilation in status asthmaticus

Gianfranco Meduri, Timothy R. Cook, Robert E. Turner, Mark Cohen, Kenneth V. Leeper

Research output: Contribution to journalArticle

254 Citations (Scopus)

Abstract

Objective: In asthmatic patients with acute respiratory failure (ARF), placing an endotracheal tube is associated with a high rate of complications and results in incrcased airway resistance. In acute asthma, mask-continuous positive airway pressure (CPAP) decreases airway resistance and the work of breathing (WOB), but does not improve gas exchange. In COPD with ARF, adding intermittent positive pressure ventilation to mask-CPAP results in an additional improvement in WOB and is highly effective in correcting gas exchange abnormalities. In our medical ICU, noninvasive positive pressure ventilation (NPPV) is used as first-line interventional therapy in eligible patients with hypercapnic ARF. We report our experience with NPPV in 17 episodes of asthma and ARF over a 3-year period. Methods: A face mask was secured with head straps, avoiding a tight fit, and connected to a ventilator (PB-7200). Initial ventilatory settings included CPAP at 4±2 cm H2O to offset intrinsic positive end-expiratory pressure and pressure support ventilation (PSV) at 14±5 cm H2O aiming at a respiratory, rate less than 25 breaths/min and an exhaled tidal volume of 7 mL/kg or more. PSV was then adjusted following arterial blood gas results. Results: Mean age was 35.4 ± 11.3 years; 10 patients were female. The mean (±SE) for different physiologic values are reported at initiation, less than 2 h, 2 to 6 h, and 12 to 24 h into NPPV. pH was 7.25±0.01, 7.32 ± 0.02 (p=0.0012), 7.36±0.02 (p<0.0001), and 7.38±0.02; PaCO2 was 65±2, 52±3 (p=0.002), 45±3 (p<0.0001), and 45±4; PaO2 fraction of inspired oxygen was 315±41, 403±47, 367±47, and 472±67 (p=0.06); and respiratory rate was: 29.1±1, 22±1 (p<0.0001), 20±1, and 17±1. NPPV was well tolerated, and only two patients required sedation. Initial delivered minute ventilation was 16±4 L/min. The mean (± SD) peak inspiratory pressure to ventilate in the NPPV- treated patients was 18±5 cm H2O and always less than 25 cm H2O. There was no complication or problem with expectorating of secretions. Oral intake (liquid diet) was preserved. Two patients required intubation (35 min and 89 h into NPPV) for worsening PaCO2. Duration of NPPV was 16±21 h. All patients survived. Length of hospital stay was 5±4 days. Conclusions: In asthmatic patients with ARF, NPPV via a face mask appears highly effective in correcting gas exchange abnormalities using a low inspiratory pressure (<25 cm H2O). A randomized study is in progress to assess fully the role of NPPV in status asthmaticus.

Original languageEnglish (US)
Pages (from-to)767-774
Number of pages8
JournalChest
Volume110
Issue number3
DOIs
StatePublished - Jan 1 1996

Fingerprint

Status Asthmaticus
Positive-Pressure Respiration
Respiratory Insufficiency
Masks
Continuous Positive Airway Pressure
Gases
Work of Breathing
Ventilation
Pressure
Airway Resistance
Respiratory Rate
Length of Stay
Asthma
Intermittent Positive-Pressure Ventilation
Tidal Volume
Mechanical Ventilators
Intubation
Chronic Obstructive Pulmonary Disease
Head

All Science Journal Classification (ASJC) codes

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

Cite this

Meduri, G., Cook, T. R., Turner, R. E., Cohen, M., & Leeper, K. V. (1996). Noninvasive positive pressure ventilation in status asthmaticus. Chest, 110(3), 767-774. https://doi.org/10.1378/chest.110.3.767

Noninvasive positive pressure ventilation in status asthmaticus. / Meduri, Gianfranco; Cook, Timothy R.; Turner, Robert E.; Cohen, Mark; Leeper, Kenneth V.

In: Chest, Vol. 110, No. 3, 01.01.1996, p. 767-774.

Research output: Contribution to journalArticle

Meduri, G, Cook, TR, Turner, RE, Cohen, M & Leeper, KV 1996, 'Noninvasive positive pressure ventilation in status asthmaticus', Chest, vol. 110, no. 3, pp. 767-774. https://doi.org/10.1378/chest.110.3.767
Meduri, Gianfranco ; Cook, Timothy R. ; Turner, Robert E. ; Cohen, Mark ; Leeper, Kenneth V. / Noninvasive positive pressure ventilation in status asthmaticus. In: Chest. 1996 ; Vol. 110, No. 3. pp. 767-774.
@article{3f969792939f4550b0472a3f6409a3ab,
title = "Noninvasive positive pressure ventilation in status asthmaticus",
abstract = "Objective: In asthmatic patients with acute respiratory failure (ARF), placing an endotracheal tube is associated with a high rate of complications and results in incrcased airway resistance. In acute asthma, mask-continuous positive airway pressure (CPAP) decreases airway resistance and the work of breathing (WOB), but does not improve gas exchange. In COPD with ARF, adding intermittent positive pressure ventilation to mask-CPAP results in an additional improvement in WOB and is highly effective in correcting gas exchange abnormalities. In our medical ICU, noninvasive positive pressure ventilation (NPPV) is used as first-line interventional therapy in eligible patients with hypercapnic ARF. We report our experience with NPPV in 17 episodes of asthma and ARF over a 3-year period. Methods: A face mask was secured with head straps, avoiding a tight fit, and connected to a ventilator (PB-7200). Initial ventilatory settings included CPAP at 4±2 cm H2O to offset intrinsic positive end-expiratory pressure and pressure support ventilation (PSV) at 14±5 cm H2O aiming at a respiratory, rate less than 25 breaths/min and an exhaled tidal volume of 7 mL/kg or more. PSV was then adjusted following arterial blood gas results. Results: Mean age was 35.4 ± 11.3 years; 10 patients were female. The mean (±SE) for different physiologic values are reported at initiation, less than 2 h, 2 to 6 h, and 12 to 24 h into NPPV. pH was 7.25±0.01, 7.32 ± 0.02 (p=0.0012), 7.36±0.02 (p<0.0001), and 7.38±0.02; PaCO2 was 65±2, 52±3 (p=0.002), 45±3 (p<0.0001), and 45±4; PaO2 fraction of inspired oxygen was 315±41, 403±47, 367±47, and 472±67 (p=0.06); and respiratory rate was: 29.1±1, 22±1 (p<0.0001), 20±1, and 17±1. NPPV was well tolerated, and only two patients required sedation. Initial delivered minute ventilation was 16±4 L/min. The mean (± SD) peak inspiratory pressure to ventilate in the NPPV- treated patients was 18±5 cm H2O and always less than 25 cm H2O. There was no complication or problem with expectorating of secretions. Oral intake (liquid diet) was preserved. Two patients required intubation (35 min and 89 h into NPPV) for worsening PaCO2. Duration of NPPV was 16±21 h. All patients survived. Length of hospital stay was 5±4 days. Conclusions: In asthmatic patients with ARF, NPPV via a face mask appears highly effective in correcting gas exchange abnormalities using a low inspiratory pressure (<25 cm H2O). A randomized study is in progress to assess fully the role of NPPV in status asthmaticus.",
author = "Gianfranco Meduri and Cook, {Timothy R.} and Turner, {Robert E.} and Mark Cohen and Leeper, {Kenneth V.}",
year = "1996",
month = "1",
day = "1",
doi = "10.1378/chest.110.3.767",
language = "English (US)",
volume = "110",
pages = "767--774",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "3",

}

TY - JOUR

T1 - Noninvasive positive pressure ventilation in status asthmaticus

AU - Meduri, Gianfranco

AU - Cook, Timothy R.

AU - Turner, Robert E.

AU - Cohen, Mark

AU - Leeper, Kenneth V.

PY - 1996/1/1

Y1 - 1996/1/1

N2 - Objective: In asthmatic patients with acute respiratory failure (ARF), placing an endotracheal tube is associated with a high rate of complications and results in incrcased airway resistance. In acute asthma, mask-continuous positive airway pressure (CPAP) decreases airway resistance and the work of breathing (WOB), but does not improve gas exchange. In COPD with ARF, adding intermittent positive pressure ventilation to mask-CPAP results in an additional improvement in WOB and is highly effective in correcting gas exchange abnormalities. In our medical ICU, noninvasive positive pressure ventilation (NPPV) is used as first-line interventional therapy in eligible patients with hypercapnic ARF. We report our experience with NPPV in 17 episodes of asthma and ARF over a 3-year period. Methods: A face mask was secured with head straps, avoiding a tight fit, and connected to a ventilator (PB-7200). Initial ventilatory settings included CPAP at 4±2 cm H2O to offset intrinsic positive end-expiratory pressure and pressure support ventilation (PSV) at 14±5 cm H2O aiming at a respiratory, rate less than 25 breaths/min and an exhaled tidal volume of 7 mL/kg or more. PSV was then adjusted following arterial blood gas results. Results: Mean age was 35.4 ± 11.3 years; 10 patients were female. The mean (±SE) for different physiologic values are reported at initiation, less than 2 h, 2 to 6 h, and 12 to 24 h into NPPV. pH was 7.25±0.01, 7.32 ± 0.02 (p=0.0012), 7.36±0.02 (p<0.0001), and 7.38±0.02; PaCO2 was 65±2, 52±3 (p=0.002), 45±3 (p<0.0001), and 45±4; PaO2 fraction of inspired oxygen was 315±41, 403±47, 367±47, and 472±67 (p=0.06); and respiratory rate was: 29.1±1, 22±1 (p<0.0001), 20±1, and 17±1. NPPV was well tolerated, and only two patients required sedation. Initial delivered minute ventilation was 16±4 L/min. The mean (± SD) peak inspiratory pressure to ventilate in the NPPV- treated patients was 18±5 cm H2O and always less than 25 cm H2O. There was no complication or problem with expectorating of secretions. Oral intake (liquid diet) was preserved. Two patients required intubation (35 min and 89 h into NPPV) for worsening PaCO2. Duration of NPPV was 16±21 h. All patients survived. Length of hospital stay was 5±4 days. Conclusions: In asthmatic patients with ARF, NPPV via a face mask appears highly effective in correcting gas exchange abnormalities using a low inspiratory pressure (<25 cm H2O). A randomized study is in progress to assess fully the role of NPPV in status asthmaticus.

AB - Objective: In asthmatic patients with acute respiratory failure (ARF), placing an endotracheal tube is associated with a high rate of complications and results in incrcased airway resistance. In acute asthma, mask-continuous positive airway pressure (CPAP) decreases airway resistance and the work of breathing (WOB), but does not improve gas exchange. In COPD with ARF, adding intermittent positive pressure ventilation to mask-CPAP results in an additional improvement in WOB and is highly effective in correcting gas exchange abnormalities. In our medical ICU, noninvasive positive pressure ventilation (NPPV) is used as first-line interventional therapy in eligible patients with hypercapnic ARF. We report our experience with NPPV in 17 episodes of asthma and ARF over a 3-year period. Methods: A face mask was secured with head straps, avoiding a tight fit, and connected to a ventilator (PB-7200). Initial ventilatory settings included CPAP at 4±2 cm H2O to offset intrinsic positive end-expiratory pressure and pressure support ventilation (PSV) at 14±5 cm H2O aiming at a respiratory, rate less than 25 breaths/min and an exhaled tidal volume of 7 mL/kg or more. PSV was then adjusted following arterial blood gas results. Results: Mean age was 35.4 ± 11.3 years; 10 patients were female. The mean (±SE) for different physiologic values are reported at initiation, less than 2 h, 2 to 6 h, and 12 to 24 h into NPPV. pH was 7.25±0.01, 7.32 ± 0.02 (p=0.0012), 7.36±0.02 (p<0.0001), and 7.38±0.02; PaCO2 was 65±2, 52±3 (p=0.002), 45±3 (p<0.0001), and 45±4; PaO2 fraction of inspired oxygen was 315±41, 403±47, 367±47, and 472±67 (p=0.06); and respiratory rate was: 29.1±1, 22±1 (p<0.0001), 20±1, and 17±1. NPPV was well tolerated, and only two patients required sedation. Initial delivered minute ventilation was 16±4 L/min. The mean (± SD) peak inspiratory pressure to ventilate in the NPPV- treated patients was 18±5 cm H2O and always less than 25 cm H2O. There was no complication or problem with expectorating of secretions. Oral intake (liquid diet) was preserved. Two patients required intubation (35 min and 89 h into NPPV) for worsening PaCO2. Duration of NPPV was 16±21 h. All patients survived. Length of hospital stay was 5±4 days. Conclusions: In asthmatic patients with ARF, NPPV via a face mask appears highly effective in correcting gas exchange abnormalities using a low inspiratory pressure (<25 cm H2O). A randomized study is in progress to assess fully the role of NPPV in status asthmaticus.

UR - http://www.scopus.com/inward/record.url?scp=0030460315&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030460315&partnerID=8YFLogxK

U2 - 10.1378/chest.110.3.767

DO - 10.1378/chest.110.3.767

M3 - Article

VL - 110

SP - 767

EP - 774

JO - Chest

JF - Chest

SN - 0012-3692

IS - 3

ER -