Use of noninvasive positive pressure ventilation via nasal mask in patients with respiratory distress after extubation.

BACKGROUND

Noninvasive positive pressure ventilation (NIPPV) has been successfully applied to provide ventilatory support in patients with chronic respiratory insufficiency as well as in selected patients with acute respiratory failure of various etiologies. To investigate the effectiveness of NIPPV via nasal mask in patients who develop respiratory distress after extubation, we prospectively studied 19 such patients (14 elective extubations and 5 self-extubations) who required no immediate reintubation.

METHODS

The BiPAP ventilatory support system (BiPAP S/T-D, Respironics Inc., Murrysville, PA) via nasal mask was used to provide NIPPV in each patient. Inspiratory pressure support was adjusted to achieve comfort as well as adequate oxygenation and ventilation.

RESULTS

Eleven patients were successfully transferred to regular oxygen supplement after an average trial of 38 hours. Persistent oral air leak despite the application of chin strap was observed in four of the eight failure cases and appeared to be the leading cause of NIPPV failure. When these patients were excluded, a success rate of 73% was achieved. Other factors contributing to failure included persistent hypoxemia, inadequate ventilation, worsening of underlying diseases and bronchial secretions. No major complication related to the use of NIPPV was observed. In the success group, respiratory rate significantly decreased by an average of 10 breaths/min at one hour after the commencement of NIPPV (p < 0.01). No significant changes of heart rate, blood pressure, Paco2 and pH were noted in either group.

CONCLUSIONS

NIPPV via nasal mask may be considered as an alternative to endotracheal reintubation in selected extubated patients with respiratory distress who require no immediate reintubation.