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.
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