Effects of support pressure ventilation with facial mask in patients with chronic respiratory failure in acute decompensation

BACKGROUND: In previous nonrandomized studies the efficacy of ventilation with back up pressure with face mask (BUPM) in the treatment of patients with chronic obstructive pulmonary disease (COPD) in acute decompensation has been demonstrated. This study analyzes the acute effects and the clinical efficacy of BUPM in a group of patients with COPD in acute respiratory failure comparing the same with conventional therapy (CONV). METHODS: A prospective randomized study including patients with COPD in acute decompensation was carried out comparing treatment with BUPM (n = 9) with CONV treatment (n = 9). Back up pressure was fixed at 20 cmH2O. Acute gasometric effects were analyzed as well as the need for intratracheal intubation, mortality and hospital stay. RESULTS: No clinical or gasometric differences were found between either group of patients upon admission. Only the patients of the BUPM group presented a significant improvement from gaseous exchange and respiratory frequency from the first hour of treatment. Three of the nine patients (33%) of the BUPM group and nine of the CONV group of patients (100%) required intubation and mechanical ventilation (p = 0.001). CONCLUSIONS: Back up pressure face mask is the technique of choice in patients with chronic obstructive pulmonary disease in acute decompensation given that this technique leads to a rapid and significant improvement of gaseous exchange and avoids the need for intubation and mechanical ventilation in most of these patients.