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 of 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 34 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).