Early Use of Noninvasive Positive Pressure Ventilation for Intro-pulmonary Acute Lung Injury

Inclusion criteria

• acute onset;
• a clinical presentation of respiratory distress;
• arterial oxygen tension/inspired oxygen fraction (PaO2/FIO2) < 300 mmHg but > 200 mmHg while breathing oxygen delivered by a conventional Venturi device at a maximum concentration (50%);
• presence of bilateral pulmonary infiltrates on posteroanterior chest radiograph;
• no evidence of left heart failure as assessed by echocardiography and/or a pulmonary artery wedge pressure of <18 mm Hg.
• the cause of ALI is consider to be intro-pulmonary.

Exclusion criteria

• age <18 yrs;
• Glasgow Coma Scale < 11;
• airway or facial injury;
• pneumothorax or pneumomediastinum;
• unable to spontaneously clear secretions from the airways;
• cardiogenic shock or severe hemodynamic instability (systolic blood pressure <90 mmHg associated with decreased urinary output (<20 mL.h-1) despite fluid repletion and use of vasoactive agents) of other causes;
• severe ventricular arrhythmia or unstable myocardial ischemia;
• severe organ dysfunction (Sequential Organ Failure Assessment score > 3);
• end-stage patients who were expected to survive < 6 months;
• severe abdominal distension;
• refusal to receive NPPV;
• the cause of ALI is consider to be extrapulmonary;
• unable to cooperate with NPPV application;
• active upper gastrointestinal bleeding.