Management of hypercapnic respiratory failure: invasive versus non-invasive ventilatory support

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Abstract

Introduction: Recently, non-invasive ventilatory support (NIVS), using a comfortable facial mask, has been used in cooperative patients, and been shown to reduce short and long-term mortality compared with invasive ventilatory support (IVS).2 Aims: We sought to respectively review the management of hypercapnic respiratory failure in patients presenting to the Alfred following the development of a NIVS protocol. Methods: Case records of all patients attending ED with dyspnoea and PaC02 45 mmHg between April and June 1999 were examined. Results: 169 cases were identified (age 60± 23 yrs, 56% female) of whom clinical evidence of COPD (52 %) and congestive heart failure (28%) were identified. As a group, in-hospital mortality was related to presenting PaC02 (9% with PaC02 45-50mmHg; 12% with PaC02 SI60 mmHg and 15 % with PaC02 61 mmHg). At the discretion of the physician, 17 % received NIVS and 17 % received IVS. Arterial blood gases (pH 7.24 vs 7.21; and PaC02 70 vs 69) were not significantly different between the NIVS and IVS groups, however the NIVS group were significantly older (77 ±13 vs 48 ±23 Years, p 0.005). Despite a greater age, the mortality was no different between the groups (21% vs 24%) yet the length of stay was significantly shorter in the NIVS group (18 vs 7 days, p = 0.022). One patient (1/29) given NIVS deteriorated despite NIVS and required IVS. Two "palliative" patients (2/29) died following withdrawal of treatment. Four patients (4/29) given NIVS were unable to tolerate NIVS for 4 hours. Conclusions: NIVS is an effective tool in the management of acute hypercapnic respiratory failure, and given the significant reduced length of stay, compared with IVS, it is very likely that NIVS will reduce healthcare costs. Whether patients in our study given IVS could have been treated with NIVS is not known, however, recently published large randomised controlled trials2 would suggest the initial use of NIVS in acute hypercapnic respiratory failure, and IVS if NIVS fails.

Original languageEnglish
Pages (from-to)A59
Number of pages1
JournalRespirology
Volume6
Issue numberSuppl. 1
Publication statusPublished - Dec 2001

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