Study
Patient population and intervention
Outcome
Tognet 1994
Hematological malignancies (HM)
ICU mortality: IMV vs NPPV: 100 % vs 55 % significantly lower mortality in NPPV group
Meduri 1994
Cancer patients with do-not-intubate orders
Solid tumor (ST) and HM
Improved survival and hospital discharge in NPPV group
Conti 1998
Immunosuppressed and HM
Improvement in blood gases and respiratory rate <1 h of NPPV – 68 % survived to discharge
Hilbert 2000
Fever, neutropenia, AHReF, HM
Intermittent CPAP
CPAP avoided ETI in 25 % CPAP success: all survived
Hilbert 2001
RCT, NPPV vs standard care (SC), fever, pulmonary infiltrate, immunosuppressed, HM n = 52
Reduced ETI, complications, ICU death, and hospital death in NPPV group
Principi 2004
Pulmonary infiltrate, HM, mask vs helmet NPPV
NPPV intolerance: helmet NPPV (0 %) vs mask NPPV (50 %)
Rocco 2004
Helmet NPPV vs mask NPPV, fever, immunosuppressed, organ transplant, pulmonary infiltrates, HM
Helmet NPPV vs mask NPPV ETI: 36 % vs 63 %
ICU mortality: (31 %) vs (47 %)
Hospital mortality: 37 % vs 53 %
Meert 2003
Solid tumors and HM, NPPV for hypoxemic ARF
ICU survival: 57 %
ETI: 25 %
64.6 Indications and Contraindications
The immediate goals of NPPV therapy should be aimed at relieving patient symptoms and reducing the work of breathing. The intermediate goals should be to improve and stabilize gas exchange and optimize patient ventilator comfort and synchrony; the ultimate goal is avoidance of ETI and IMV. The success of therapy depends on a highly motivated, committed, and knowledgeable team and careful patient selection with the help of a well-structured NPPV guideline (Table 64.2). Application of NPPV early in the process of ARF, along with careful and rigorous monitoring, is vital to the success of NPPV therapy. Other factors include location and availability of a wide variety of interfaces to suit the patient’s morphological and comfort needs.
Table 64.2
NPPV for cancer patients (©The University of Texas M.D. Anderson Cancer Center NPPV guideline)
Eligibility criteria | Contraindications |
|---|---|
Clinical (all) Acute respiratory failure Dyspnea Accessory resp. muscle use Paradoxical abdominal movement RR > 25 Adequate airway protection Adequate secretion clearance | Absolute (any) Cardiopulmonary arrest pH < 7.25 Upper airway obstruction Facial trauma Uncontrolled arrhythmia Untreated SBP ≤ 90 mmHg GCS ≤ 8 Undrained pneumothorax
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