Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Critical Care Medicine


Answer 3
  1. Immunosuppressed patients with acute respiratory failure benefit from NIPPV. Although intubation with invasive mechanical ventilation is often necessary for patients with ALI/ARDS, immunosuppressed patients benefit greatly by avoiding an endotracheal tube and its attendant risk of infection. Immunosuppressed patients with early respiratory failure randomized to NIPPV versus high-flow oxygen alone demonstrated decreased rates of intubation, ICU mortality, and hospital mortality.5 Thus, a brief trial of NIPPV with close monitoring is appropriate. Adequate noninvasive ventilation for ALI often requires IPAP of at least 15 cm H2O and PEEP of 6 cm H2O to 8 cm H2O.5 Skin necrosis may be a problem, particularly at the bony prominences of the face in contact with the NIPPV mask (eg, bridge of the nose, chin). Skin necrosis occurs when IPAP exceeds capillary perfusion pressure; therefore, IPAP should not exceed 22 cm H2O. Aerophagia, or swallowing of air, is also a potential problem with NIPPV and is generally an issue when IPAP exceeds 20 cm H2O. Immunosuppressed patients do not have a higher rate of aspiration than other hospitalized patients.

    REFERENCES
    5. Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001;344: 481-7.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 10/5/07 • kkj