Folia Medica 63(3): 321-328, doi: 10.3897/folmed.63.e55150
Non-invasive ventilation: a safe and effective respiratory support method in hypoxemic acute respiratory failure due to pneumonia with or without acute respiratory distress syndrome
expand article infoViktoria Ilieva, Yordanka Yamakova
‡ Department of Anesthesiology and Intensive Care, Medical University - Sofia, Bulgaria, Sofia, Bulgaria
Open Access
Abstract

Introduction: The benefit of non-invasive ventilation (NIV) in cases of hypercapnic acute respiratory failure (ARF) has already been proven. Still, its safety and efficacy as a respiratory support method for patients with hypoxemic ARF hasn’t been studied so well.

Aim: The aim of our study was to examine the safety and efficacy of NIV in hypoxemic ARF of primary lung origin.

Materials and methods: This was a prospective observational cohort study of patients with hypoxemic ARF due to community
acquired pneumonia with or without acute respiratory distress syndrome (ARDS) treated using NIV. They were divided into four groups: pneumonia without ARDS, mild, moderate, or severe ARDS. Their clinical and ABG parameters were recorded before initiation of NIV, at 1 hour and 24 hours after ventilation onset and at transition to non-intensive NIV or before endotracheal intubation in NIV failure cases.

Results: A total of 63 patients were included. NIV trial was successful in 85.71% of them, while 14.29% experienced NIV failure. In the general population, we observed a significant difference in PaO2/FiO2 only before transition to non-intensive NIV in comparison to the value at admission. This trend was seen in the patients with pneumonia without ARDS and moderate ARDS, but not in those with mild and severe ARDS. The clinical parameters showed improvement early in the course of treatment both in the entire study population and all subgroups.

Conclusions: NIV is an effective and safe option for respiratory support in patients with severe CAP only when an adequate etiological treatment has been applied.

Keywords
ARDS, non-invasive ventilation, pulmonary inflammation