Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (17)
Secondly, when the electromyographic activity of the diaphragm was recorded in a few acutely ill patients submitted to NPPV the mean amplitude of this signal decreased more in restrictive than in obstructive disease at a similar level of nasal mask pressure delivered by the respirator. It seems therefore that if one of the goals of assisted ventilation is to provide rest, particularly to inspiratory muscles by taking over their respiratory work, this purpose may not be achieved in patients with COPD. This possible failure of acute NPPV in patients with bronchial obstruction parallels strikingly the data on long-term home positive-pressure ventilation; the survival of patients with restrictive pulmonary diseases is clearly and impressively prolonged by these techniques, whereas patients with obstructive disease seem not to benefit from mechanical ventilation.
The amount of work imposed on the ICU team, particularly on nurses, when acute NPPV is provided to a patient is impressive when we consider our data. The generalized limited availability both of experienced ICU nurses and of health-care financial resources makes it necessary to examine the physicians role in the utilization of nursing capabilities. The “ideal” nurse/patient ratio in the ICU was considered to be quite high (ie, close to 1:1) in the initial years of the modern ICU era.