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Interface strategy during noninvasive positive pressure ventilation for hypercapnic acute respiratory failure*

Girault, Christophe MD; Briel, Anca MD; Benichou, Jacques MD, PhD; Hellot, Marie-France ScD; Dachraoui, Fahmi MD; Tamion, Fabienne MD, PhD; Bonmarchand, Guy MD, PhD

doi: 10.1097/CCM.0b013e3181928706
Clinical Investigations

Objective: To assess the influence of initial mask choice on the clinical effectiveness and tolerance of noninvasive positive pressure ventilation (NIPPV) in the management of hypercapnic acute respiratory failure.

Design: A prospective randomized controlled clinical study.

Setting: A medical intensive care unit at a university hospital.

Intervention: Randomization between two NIPPV interfaces.

Patients: Initial mask choice was randomized between two standard masks: face (NIPPVf group) and nasal (NIPPVn group). The main end point was mask failure (i.e., mask change and/or intubation). Secondary end points were tolerance of NIPPV, change in respiratory parameters during the first 3 days, and patient outcome. Results were analyzed on an intent to treat basis. A per protocol analysis was also conducted.

Main Results: Ninety patients with underlying chronic lung disease were included, 46 in the NIPPVf group and 44 in the NIPPVn group. The overall success rate of NIPPV was 83%. Mask failure occurred significantly more often in the NIPPVn group (32/44 vs. 9/46; p < 0.0001), mainly because of the need for mask change (32/44 vs. 0/46; p < 0.0001) because of the occurrence of major buccal air-leaks in 94% of cases. Improvement in respiratory parameters was similar in the two groups. Whereas air-leaks were more frequent in the NIPPVn group (p < 0.05), respiratory comfort was assessed as lower and complications more frequent by the staff in the NIPPVf group from day 2 (p < 0.05).

Conclusions: A face mask should be the first-line strategy in the initial management of hypercapnic acute respiratory failure with NIPPV. However, if NIPPV has to be prolonged, switching to a nasal mask may improve comfort by reducing face mask complications.

From the Department of Medical Intensive Care (CG, AB, FD, FT, GB), Rouen University Hospital, Rouen, France; GRHV Research Group (CG, GB), UPRES EA 3830-IFRMP.23, Institute for Biomedical Research, Rouen University, Rouen, France; Department of Biostatistics (JB, MFH), Rouen University Hospital, Rouen, France; and Inserm U 657 (JB), Bordeaux, France.

Presented, in part, at the American Thoracic Society International Conference, San Diego, May 19–24, 2006.

The authors have not disclosed any potential conflicts of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins