Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (10)
We decided to teach her NPPV, because there was a possibility that delivery should be performed by a cesarean section. Despite 15 days of teaching of NPPV in this strongly motivated and cooperative patient, we were never successful in normalizing PaC02, which remained constantly greater than 6 kPa (45 mm Hg). The delivery’ was uneventful, with a cesarean section performed under epidural anesthesia; however, during the postpartum period the patients respiratory situation deteriorated rapidly, with increasing dyspnea and bronchial secretions, probably due to superinfection.
About ten days after delivery, the PaCOa increased (6.5 to 7 kPa [50 to 53 mm Hg]), and it was obvious that this exhausted patient would soon need respiratory mechanical support. Because of the high risk of lethal septicemia in intubated patients with cystic fibrosis, we decided to introduce NPPV instead of classic IPPV. For ten days, this highly motivated patient tried to use NPPV; the airway pressure was rather high (35 to 40 cm HzO), and tolerance of the nasal mask was difficult. We were able to lower the PaC02 (4.9 kPa [37 mm Hg]) from time to time, but eventually the patient was exhausted and had to be intubated. As expected, three days later, septic shock due to Pseudomonas aeruginosa septicemia supervened. We were unable to find a compatible donor for heart-lung transplantation, and the patient died a few days later.