Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (9)
Fifteen days before admission, a bronchopulmonary infection occurred and, for the first time, ankle edema. The patient was hospitalized with fever, severe dyspnea, drowsiness, and acute-on-chronic severe respiratory acidosis (PaCOs, 10 kPa [75 mm Hg]) with hypoxemia despite controlled oxygenation.
Intubation and mechanical ventilation were therefore recommended; however, for unclear reasons the patient and his wife refused but agreed to attempt NPPV We thus tried to use this technique; in two consecutive days, we were only able to ventilate the patient during 8 h, in short sessions of 20 to 30 min, because of poor cooperation, probably due to the high airway pressures (>30 cm HaO) necessary to inflate his chest. The PaC02 decreased from 10 kPa (75 mm Hg) to 8.1 kPa (61 mm Hg), but finally, the patient was exhausted and agreed to intubation and mechanical ventilation. After 11 days of classic IPPy he could be weaned and left the hospital one month later.
This 26-year-old woman suffered from cystic fibrosis with severe airflow obstruction (lable 2). Nevertheless, she decided to become pregnant. During the last three months of her pregnancy, the results of her pulmonary function tests worsened, and she was severely dyspneic and hypercapnic (PaCOa, 6.4 kPa [48 mm Hg]).