[Non-invasive positive pressure ventilation in patients with acute respiratory distress syndrome: a prospective cohort study].

Objective: To investigate the efficiency of the application of non-invasive positive pressure ventilation (NPPV) as a first-line intervention in patients with acute respiratory distress syndrome (ARDS).

Methods: A prospective cohort study was designed to analyze the clinical data of patients with ARDS in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital admitted between January 2004 and December 2007.

Results: (1)31 patients, age (49+/-17) years, with acute physiology and chronic health evaluation II (APACHEII) score of 14+/-8 and oxygenation index (PaO(2)/FiO(2) of (123+/-32) mm Hg (1 mm Hg=0.133 kPa), were enrolled in the study. There were 23 males and 8 females. (2)The successful rate of NPPV was 74.2% (23/31) and it was significantly higher in patients without pulmonary infection than that in patients with pulmonary infection (100% vs. 60%, P=0.017). (3)In the successful group, heart rate (HR), respiratory rate (RR) and PaO(2)/FiO(2) were improved significantly at the time of 2 hours and 24 hours of NPPV compared with NPPV before (all P<0.01), while there was no significant improvement observed in the failure group. Furthermore, an increase in arterial partial pressure of carbon dioxide (PaCO(2)) was observed in the latter (P<0.05). No serious complications were seen in association with NPPV in all recruited patients.

Conclusion: NPPV may be the first-line intervention for a selected group of ARDS patients, while invasive ventilation should be considered for those patients with high risk of NPPV failure as indicated by worsening of vital signs and arterial blood gas analysis after a short time of using NPPV, and also in cases where pulmonary infection is the underlying disease of ARDS.