Intensive care mechanical ventilators with non-invasive mode: Are they more successful in

noninvasive ventilation?

Nalan Adıgüzel, Zuhal Karakurt, Gökay Güngör, Özlem Yazıcıoğlu Moçin, Merih Kalamanoğlu Balcı, Eylem Acartürk, Hüseyin Arpağ, Adnan Yılmaz.

Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi,

Solunumsal Yoğun Bakım Ünitesi, İstanbul, Türkiye

Designed to ventilate intubated patients, with minimal or no leak

These machines have been increasingly used for NIV over the years

Intensive Care Ventilators(ICV)

Leaks at the patient-mask interface:Decrease tolerance to NIV

Interfere with several key aspects of ventilator fuction (autotriggering, decreased pressurization,premature cycling…)

Patient- ventilator asynchrony

Enhancing ventilator performance to minimize the negative impact of leaks, NIV modes integrated to ventilators

Aim

The success of noninvasive ventilation at 1st and 24th hours

of ventilation, using intensive care ventilators with and without noninvasive mode(NIV), for patients presenting with acute respiratory failure(ARF) were compared

Methods-I

Study design: prospective, observational, clinical study

Study period : October 2009 to December 2009

Yer: Respiratory ICU

Patients: 45 patients with ARF treated by NIV

Methods-II: Patient groups

Patient recordsICU ventilators with

NIV modeICU ventilators without NIV mode

Group 1 Group 2

• Demographic findings

• APACHE II score

• ABG at NIV 1st ve 24th

hours

• NIV mode

• NIV failure:

(entubation)

• Length of ICU stay

• Mortality

Two groups compared according to demograhic characteristics, NIV success and mortality

Grup 2

• ICU data

• NIV success

• mortality

Methods-III

Results-I

Table 1 Patient characteristics

Group 1(n:21) Group 2 (n:24)

Age*, mean(SD) 62.5 (8.9) 70.2 (9.9)

Gender (F/M) 6/15 13/11

APACHE II, mean(SD) 19.3(5.0) 21.5(5.5)

Diagnosis,Obstructive , n(%) 20(%95) 20(%83)

Diagnosis,Restrictive, n(%) 1(%5) 4(%17)

pH,mean(SD) 7.266(0.052) 7.280(0.060)

PaCO2, mean(SD) 85.4(14.9) 81.3(17.1)

PaO2,mean(SD) 68.2(25.5) 78.7(49.7)

HCO3, mean(SD) 37.0(6.9) 36.7(10.0)

age p<0.010, others p value >0.05

Table 3 Results of NIV

Group 1(n: 21)n(%)

Group 2(n: 24)n(%)

NIV mode 1st hr

PSV 8(%38) 8 (%33.3)

A/C PCV 13 (%62) 16 (%66.7)

NIV mode 24th hrPSV 5 (%24) 7 (%29)

A/C PCV 16 (%76) 17 (%61)

ABG 1st hr pH 7.338(0.084) 7.315(0.040)

PaCO2 74.7(18.1) 70.8(13.1)

ABG 24th hr pH 7.343(0.095) 7.393(0.123)

PaCO2 70.9(17.4) 65.9(20.0)

NIV failure 5 (%23.8) 5 (%20.8)

Length of ICU stay, median(IQR) 8 (5-10) 8 (5-12)

ICU mortality 2 (%9.5) 3 (%12.5)

Reason of NIV failure

Secretion(a) 1 (%4.8) 0

No clinical response(b) 1 (%4.8) 1 (%4.2)

Deterioration of ABG 1 (%4.8) 0

More than one reason (a,b,c,asynchrony) 2 (9.5) 4(%16.6)

p>0.050

Conclusion

It was detected that presence of NIV mode in ICV during NIV did not influence NIV success in our patients having ARF with same level of disease severity

The reason of no difference can be attributed performing NIV with controlled mode and minimal mask-interface leak.