Nasal continuous positive airway pressure: An alternative method for respiratory assistance

Natan Weksler, Leon Ovadia

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Study Objective: To examine the efficacy of a nasal continuous positive airway pressure (CPAP) system for respiratory support in patients who have respiratory insufficiency but are able to maintain spontaneous breathing without hypercapnia, respiratory acidosis, or deteriorated mental status. Design: Prospective study. Setting: Medical and surgical patients admitted to the intensive care unit (ICU) at the Hillel Yaffe Medical Center. Patients: Nineteen patients with acute respiratory insufficiency and intact mental status who were able to maintain spontaneous breathing without hypercapnia or respiratory acidosis. Additional entry criteria were as follows: arterial oxygen tension (PaO2) < 65 mmHg on inspired oxygen tension (FIO2) ≥0.45, PaO2/FIO2 <150, respiratory rate >35 breaths/minute, and inability to tolerate mask CPAP. Interventions: Nasal CPAP (10 cmH2O) was applied to patients through two nasopharyngeal airways with an internal diameter (ID) of 8 mm each, inserted in both nostrils. During CPAP application, the patients were requested to breathe through their nose with their mouth closed. Even if they breathed through their open mouth, however, CPAP was maintained despite an observed pressure decrease of 4 cmH2O. Measurements and Main Results: All patients showed a constant improvement in arterial blood gases, PaO2/FIO2, and respiratory signs during nasal CPAP of 10 cmH2O. PaO2 increased from 52 ± 5.3 mmHg to 131 ± 20 mmHg with CPAP administration (p < 0.05), while arterial carbon dioxide tension (PaC02) increased from 32 ± 2 mmHg to 36 ± 2 mmHg (p < 0.05) and respiratory rate decreased from 39 ± 2.3 breaths/minute to 31 ± 1.6 breaths/minute (p < 0.05). Conclusions: Nasal CPAP (10 cmH2O) is a reliable alternative to support arterial oxygenation in patients with respiratory failure who are alert and vigorous enough to avoid hypercapnia and respiratory acidosis while breathing spontaneously. In addition, since the patients are able to speak and thus are capable of expressing their feelings, the anxiety observed during respiratory support can be reduced.

Original languageEnglish
Pages (from-to)442-446
Number of pages5
JournalJournal of Clinical Anesthesia
Volume3
Issue number6
DOIs
StatePublished - 1 Jan 1991
Externally publishedYes

Keywords

  • Continuous positive airway pressure (CPAP)
  • anesthesia
  • respiratory failure
  • respiratory support

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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