An evaluation of the role of noninvasive positive pressure ventilation in the management of acute respiratory failure in a developing country

Objective: Noninvasive positive pressure ventilation (NIPPV) has been shown to decrease the need for invasive mechanical ventilation (MV) in patients presenting with acute respiratory failure (ARF). We conducted a prospective study to assess if NIPPV use, in a developing country, was associated with clinical and physiological improvements. Design: Prospective observational study. Materials and Methods: Forty patients admitted to a medical intensive care unit during a 2-year period who fulfilled criteria for inclusion formed the study cohort to receive NIPPV. Findings: Baseline (mean ± SD) pH, PaCO 2 and PaO 2 were 7.25 ± 0.08, 76.6 ± 20.9 and 79.18 ± 40.56 mmHg respectively. The primary indication for NIPPV was hypercapnic respiratory failure (n = 36, 90%). The success rate with NIPPV was 85%, with 34 of 40 patients weaned successfully. Significant improvements were observed at 1 hour following institution of NIPPV in pH (7.31 ± 0.09, P < 0.001) and PaCO 2 (65 ± 17.9, P < 0.001). These improvements continued up to the time of weaning (pH 7.38 ± 0.08, PaCO 2 54.7 ± 20) and maintained (within 12 h) postweaning from the ventilator (pH 7.39 ± 0.08, PaCO 2 51.9 ± 12.4). No significant change in the PaO 2 was observed during NIPPV; PaO 2 after 1 h, prior to weaning and after weaning was 90.53 ± 42.85, 84.80 ± 33.76, 78.71 ± 43.81 respectively. Conclusion: This study has demonstrated benefits of NIPPV in avoiding the need for invasive MV in patients presenting with ARF of diverse etiology, with results comparable to developed nations. Increased use of NIPPV in ARF is likely to impact favorably in nations with limited resources