Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (20)

It is therefore possible that by adding this extra amount of nurse/patient ratio for one or a few patients, a given ICU might become “saturated” and that the treatment of all patients in this ICU could be compromised; a superimposed ratio of around 0.20 may represent almost 50 percent of the average nursing task force available in some ICU s.
One could argue that our lack of success in half of our patients might have been due to the use of an inappropriate ventilation technique, namely, the as-sist-control mode during IPPV (AC-IPPV), or to the requirement of a nasal instead of a facial mask. Recently, Brochard and colleagues published interesting results in decompensated patients with COPD who were ventilated via a facial mask with pressure-support type of ventilation (PSV). Compared to matched historic control patients, the PSV-treated patients had a more transient need for ventilatory assistance and a shorter stay in the ICU. In some of these patients, an endotracheal intubation might have been obviated; however, the patients of Brochard et al were probably less severely decompensated than ours, when considering arterial blood gas levels, particularly pH and PaC02.

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