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Free MCQ Question of the Week
Which of the following is an accepted indication for initiation of noninvasive positive pressure ventilation (NIPPV) with established evidence?
- Acute respiratory failure in immunocompromised patients
- Status asthmaticus while awaiting intravenous steroids to work
- Patients with severe burns to avoid further mucosal injury from endotracheal tube
- Patients with mild forms of acute respiratory distress syndrome
Answer: Acute respiratory failure in immunocompromised patients
Studies suggests that NIPPV is associated with decreased ICU mortality, intubation rate, and ICU length of stay among immunocompromised patients with acute respiratory failure, when compared to invasive mechanical ventilation as the first modality of ventilator support. These outcomes are probably a consequence of fewer nosocomial infections among patients given a trial of NIPPV before moving forth with invasive mechanical ventilation. Therefore option A is correct
In a very small study of 30 emergency department patients, the use of NIPPV in severe asthma exacerbation resulted in a favorable outcome. However, this has not been replicated in larger studies, and thus should not be considered standard of care – option B is thus incorrect.
Patients with severe burns and airway involvement typically get worse before they get better, and take a long time to recover. There are no studies to suggest a beneficial outcome with NIPPV use in this population. While there may be special scenarios where NIPPV might be tried, as a group, there are no studies to show that those with ARDS – even those with milder disease – would benefit from NIPPV
Contributed by Dr. Shyoko Honiden, http://M.Sc . M.D., is an Asst Prof of Medicine at the Yale School of Medicine & Dr Dr. Mark David Siegel, the Director of the Traditional Internal Medicine Residency at Yale. @HeartBobH @FutureDocs @StanfordDeptMed @UCSFHospitals