NONINVASIVE MECHANICAL VENTILATION VIA FACE MASK IN PATIENTS WITH ACUTE RESPIRATORY-FAILURE WHO REFUSED ENDOTRACHEAL INTUBATION

Objective: To evaluate the response to noninvasive ventilation in a gr oup of terminally ill patients with acute respiratory failure who refu sed endotracheal intubation. Design: Case series. Setting: Medical int ensive care units (ICUs) in a university health science center. Patien ts: Eleven patients, nine with hypercapnic and two with hypoxemic acut e respiratory failure. Mean age of patients was 64 yrs. Intervention: Mechanical ventilation was delivered via a face mask. The initial vent ilatory setting was continuous positive airway pressure mode, with pre ssure-support ventilation of 10 to 20 cm H2O, titrated to achieve a re spiratory rate of <25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. Measurement s and Main Results: Mechanical ventilation via face mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation vi a face mask was effective in improving respiratory acidosis in three p atients and had no effect in one patient. Two of the four patients cou ld not be weaned from mechanical ventilation and opted for discontinua tion of this method. Removal of the ventilator while retaining the mas k for oxygen supplementation was a nontraumatic experience to the pati ent and family. Even when respiratory failure did not resolve, mechani cal ventilation via face mask was effective in lessening dyspnea and a llowed the patient to maintain autonomy and continuous verbal communic ation. Conclusions: We conclude that mechanical ventilation via face m ask offers an effective, comfortable, and dignified method of supporti ng patients with end-stage disease and acute respiratory failure.