Sep 20, 2012 - Marco Confalonieri; Stefano Aiolfi; and Alessandro Scartabellati. 15 December 1994 | Volume 121 Issue 12 | Pages 984-985. To the Editor: We ...
Ann Intern Med -- Confalonieri et al. 121 (12): 984
20/09/12 06:31
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LETTER
Noninvasive Ventilation Marco Confalonieri; Stefano Aiolfi; and Alessandro Scartabellati 15 December 1994 | Volume 121 Issue 12 | Pages 984-985
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To the Editor: We read with interest Meyer and Hill's excellent review on noninvasive positive pressure ventilation [1]. The authors provide some selection guidelines for its use that are based on reports in the literature. According to those guidelines, noninvasive positive pressure ventilation should be avoided in patients with acute respiratory failure associated with hemodynamic instability.
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PubMed Articles in PubMed by Author: Confalonieri, M. Scartabellati, A.
We have noted that not all the cited reports included information on the hemodynamic status among their selection criteria in patients with acute disease. Further, when excluding hemodynamically unstable patients, the authors failed to define hemodynamic stability.
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It is well known that conventional mechanical ventilation by endotracheal intubation may seriously alter hemodynamic status (particularly when external positive end-expiratory pressure, invasive positive pressure ventilation, or intermittent mechanical ventilation is used) [2]. Hemodynamic status is less affected in patients treated with pressure support ventilation [3]. We know of no reports of similar adverse effects of noninvasive positive pressure ventilation when nasal or facial masks are used. Therefore, could this type of ventilation represent a possible alternative ventilatory treatment in patients with hemodynamic instability? We used bilevel positive airway pressure ventilation (BiPAP; Respironics, Inc.) through a nasal mask to ventilate 57 consecutive, unselected patients with acute respiratory failure who were unresponsive to oxygen and medical therapy alone. We applied noninvasive positive pressure ventilation for almost 22 hours daily, with a median inspiratory positive airway pressure of 15 cm H2O (maximum, 20 cm H2O; minimum, 8 cm H (2O)) and a median expiratory positive airway pressure of 4 cm H2O (range, 8 cm H2O to 3 cm H2O). Seven patients had hypotension (systolic blood pressure
