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Revista Médica del Uruguay

On-line version ISSN 1688-0390


FRANCA, Ana Graciela; FORMENTO, Carlos Ignacio; OLIVERA, Soledad  and  BOCCHI, Alejandro Ebeid. Asistencia ventilatoria no invasiva en el tratamiento inicial de la insuficiencia respiratoria aguda. Rev. Méd. Urug. [online]. 2014, vol.30, n.3, pp.168-178. ISSN 1688-0390.

Abstract Introduction: invasive mechanic ventilation implies increased risk of pneumonia and traumatic damage of the airway. Non-invasive ventilation proved benefits in acute respiratory failure, in chronic obstructive pulmonary disease (COPD) and in acute cardiogenic pulmonary edema (CPE), although it resulted heterogeneous in non-cardiogenic pulmonary edema hypoxemic respiratory failure. Objectives: to evaluate non-invasive ventilation in hypoxemic and hypercapnic acute respiratory failure as an initial treatment. Response, evolution, risk of failure and death. Method: prospective cohort study that included immunocompetent adults treated with non-invasive ventilation. Period: January, 2011 through July, 2013. The study included patients with hypercapnic acute respiratory failure hospitalized in a 16 bed ICU: carbon dioxide blood pressure (PaCO2) ≥45 mm Hg, and pH ≤7.35 and >7.25, or hypoxemic acute respiratory failure: oxygen blood pressure (PaO2) with oxygen mask >80 and ≤150 mmHg. Patients would be excluded if there was an indication of immediate intubation, sensory depression, hemodynamic instability, bronchoplegia. Results: the study comprised 61 patients, 62 ± 14 years old (average age ± 1 standard deviation). Apache II scores were 15 ± 5.5. Thirty six patients had hypoxemic acute respiratory failure, 9 of them failed (25%) and 7 died (19%); there were 25 patients with hypercapnic acute respiratory failure, 5 of them failed (20%) and 4 died (16%). Those who failed had a longer hospitalization, p=0.01, a higher incidence of respiratory infections, and extra-respiratory infections p=0.03. The independent risk factors associated to failure and death (logistic regression) were the following: ·  Failure: every unit increase in the respiratory rate in the first hour of non-invasive ventilation, odds ratio (OR) 2.2 (IC 95% 1.4-3.5). ·  Death: failure of the non-invasive ventilation, OR 19.5 (IC 95% 4.0-94.6). Conclusions: each increase of the respiratory rate in the first hour of non-invasive ventilation doubles the risk of failure and the latter multiplies by twenty the probability of death.


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