Feasibility Study of the Use of Bilevel Positive Airway Pressure for Respiratory Support in the Emergency Department☆,☆☆,★,★★,♢
Section snippets
INTRODUCTION
There are growing clinical and fiscal pressures to avoid endotracheal intubation (ETI) and mechanical ventilation (MV) whenever feasible. In postanesthesia recovery units, critical care units, and in-home use, noninvasive bilevel positive airway pressure (BiPAP) support of spontaneous ventilation by face mask has conclusively been demonstrated to help physicians avoid ETI/MV in a variety of clinical settings.1, 2, 3, 4, 5 The ability to support noninvasively some emergency department patients
MATERIALS AND METHODS
Any patient who presented to our ED during the 8-month study period with ARD of any nontraumatic cause and who was hemodynamically stable with a patent airway was considered eligible for the protocol. Patients deemed to require immediate ETI for treatment of apnea or maintenance of airway protection were excluded. Because strict parameters for inclusion could not be developed, consistency of eligibility determination was ensured by having one of the authors (CP or MT) evaluate each potential
RESULTS
Fifty patients were enrolled in the study during an 8-month period. The causes of ARD in this population included acute CHF (n=16), exacerbation chronic obstructive pulmonary disease (COPD; n=9), mixed COPD/CHF (n=3), pneumonia (n=10), status asthmaticus (n=6), and other causes of acute respiratory failure (eg, cerebrovascular accident, overdose; n=6). Final IPAP settings ranged from 9 to 22 cm H2O, and EPAP from 3 to 9 cm H2O. ABG data and BiPAP settings are presented by cause of ARD in the
DISCUSSION
Advantages of noninvasive ventilation include avoidance of the risks, complications, and expense of ETI/MV; greater patient comfort; reduced need for sedation; lower risk of nosocomial infections; and preservation of speech, swallowing, and normal airway defense mechanisms. Disadvantages include sacrifice of the definitive control of airway and ventilation afforded by ETI/MV; the need for patient cooperation; impaired access to the airway for suctioning; facial skin pressure stress; and
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Cited by (0)
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From the Departments of Emergency Medicine* and Respiratory Therapy‡, Maricopa Medical Center, Phoenix, Arizona.
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This study was supported by the loan of a BiPAP S/T noninvasive ventilatory by Respironics, Incorporated.
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Dr Pollack serves on the Speakers Bureau of Respironics Inc.
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Address for reprints: Charles V Pollack Jr, MA, MD, PO Box 37936, Phoenix, Arizona 85069-7936, 602-267-5418, Fax 602-331-0716, E-mail [email protected]
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Reprint no. 47/1/69973