Abstract

DUARTE, Tiago Isidoro et al. Non-Invasive Mechanical Ventilation: How to Identify Response?. Medicina Interna [online]. 2019, vol.26, n.2, pp.113-119. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/O/17/19/2/2019.

Introduction: Noninvasive mechanical ventilation has been established as a successful therapeutic option in respiratory failure, as it reduces the complications associated with invasive mechanical ventilation and improves hospital survival. Our objectives was to describe a population of patients who needed noninvasive mechanical ventilation at an Intermediate Care Unit and identify possible predictive indicators of response to therapy. Methods: Prospective observational study conducted over 6 months that included patients with hypercapnic and/or hypoxemic respiratory failure which needed noninvasive mechanical ventilation. Results: Thirty-four of 128 patients were identified, mean age 77 year-old, 71% male. Score SAPS II and average Charlson index of 46 and 7, respectively. Twenty-two patients started noninvasive mechanical ventilation at the Emergency Department, 6 at the unit and the remaining 6 at the Internal Medicine ward. Main reasons for its introduction: acute cardiogenic lung edema (50%) and acute chronic obstructive pulmonary disease (26%). The rate of therapeutic failure was 29%. After 24 hours of noninvasive mechanical ventilation, the differences found between the response and the therapeutic failure group were statistically significant (pH 7.37 vs 7.32; p Conclusion: Noninvasive mechanical ventilation reduces patient morbi/mortality through close clinical and arterial gasimetry monitoring. pH variation seems to be the best predictor of response, allowing early recognition of therapeutic failure and facilitating the use of other therapeutic options in advance.

Keywords : Noninvasive Ventilation; Respiratory Insufficiency/ therapy; Respiration, Artificial; Treatment Outcome.

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