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Interface strategy during noninvasive positive pressure ventilation for hypercapnic acute respiratory failure*
Crit Care Med. 2008 Nov 28;
Authors: Girault C, Briel A, Benichou J, Hellot MF, Dachraoui F, Tamion F, Bonmarchand G
OBJECTIVE:: To assess the influence of initial mask choice on the clinical effectiveness and tolerance of noninvasive positive pressure ventilation (NIPPV) in the management of hypercapnic acute respiratory failure. DESIGN:: A prospective randomized controlled clinical study. SETTING:: A medical intensive care unit at a university hospital. INTERVENTION:: Randomization between two NIPPV interfaces. PATIENTS:: Initial mask choice was randomized between two standard masks: face (NIPPVf group) and nasal (NIPPVn group). The main end point was mask failure (i.e., mask change and/or intubation). Secondary end points were tolerance of NIPPV, change in respiratory parameters during the first 3 days, and patient outcome. Results were analyzed on an intent to treat basis. A per protocol analysis was also conducted. MAIN RESULTS:: Ninety patients with underlying chronic lung disease were included, 46 in the NIPPVf group and 44 in the NIPPVn group. The overall success rate of NIPPV was 83%. Mask failure occurred significantly more often in the NIPPVn group (32/44 vs. 9/46; p < 0.0001), mainly because of the need for mask change (32/44 vs. 0/46; p < 0.0001), because of the occurrence of major buccal air-leaks in 94% of cases. Improvement in respiratory parameters was similar in the two groups. Whereas air-leaks were more frequent in the NIPPVn group (p < 0.05), respiratory comfort was assessed as lower and complications more frequent by the staff in the NIPPVf group from day 2 (p < 0.05). CONCLUSIONS:: A face mask should be the first-line strategy in the initial management of hypercapnic acute respiratory failure with NIPPV. However, if NIPPV has to be prolonged, switching to a nasal mask may improve comfort by reducing face mask complications.
PMID: 19050635 [PubMed - as supplied by publisher]