Chest
Clinical InvestigationsVENTILATORSNoninvasive Positive-Pressure Ventilation vs Conventional Oxygen Supplementation in Hypoxemic Patients Undergoing Diagnostic Bronchoscopy
Section snippets
Materials and Methods
Between May 1998 and January 1999, all consecutive patients with acute hypoxemic respiratory failure and suspected nosocomial pneumonia who were admitted to a 14-bed general ICU at La Sapienza University Hospital (Rome, Italy) were screened for enrollment into the randomized study. An ad hoc ethics committee approved the protocol, and all patients gave informed consent. Computer-generated random assignments were put into sealed envelopes. The criteria for hypoxemic respiratory failure included
Results
Over a period of 9 months, 365 patients were admitted to the ICU. Of the 81 patients who met the study entry criteria, 30 were already intubated, 10 had a tracheostomy, 6 had mental status alterations or hemodynamic instability, and 9 refused to participate. Thus, 26 patients (16 men and 10 women) were enrolled into the study. Thirteen patients were assigned to each group. At study entry, the baseline characteristics of the two groups were similar, including severity of disease as calculated by
Discussion
In this randomized study, we found that, in patients with severe hypoxemia (ie, Pao2/Fio2 ratio, < 200), NPPV that was delivered through a full-face mask was superior to oxygen supplementation alone in improving gas exchange during and after diagnostic bronchoscopy. The procedure was well-tolerated and was not associated with complications. Following bronchoscopy, patients who were randomized to NPPV had less of a reduction in MAP and a lower heart rate. The rates for intubation within 10 h of
ACKNOWLEDGMENT
We wish to acknowledge the expert review of the manuscript by Dr. David Armbruster and Mrs. Gail Spake. Also, we thank participating investigators Maurizio Bufi (collected data), Mariano Alberto Pennisi (collected data), Riccardo Maviglia (provided and cared for study patients), and Paolo Pietropaoli (critically revised the study proposal).
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