Non-Invasive Positive Pressure Ventilation and Adult Respiratory Distress Syndrome (ARDS)

Methods: This study was performed in the respiratory intensive care unit (ICU) at a university hospital. 20 patients who achieved the diagnostic criteria for ARDS were included. The patients were prospectively allocated into two groups: a standard therapy group and a NPPV group. Invasive mechanical ventilation indications had been determined before the study. Invasive ventilation was applied to those who in need of intubation, while those given intubation received a standard medical treatment.

Inclusion criteria

The following criteria indicated immediate intubation was needed:

• Apne or respiratory pauses with loss of consciousness or gasping for breath or imminent respiratory arrest.
• Inability to increase the patient's PaO2 to more than 40 mmHg and SpO2 to more than 80% with a FiO2>0.6.
• Inability to increase the patient's pH levels above 7.35, and development of blurred consciousness and confusion (Glasgow Coma Scale <9) due to respiratory acidosis despite all the support given.
• Instability of the patient's hemodynamic parameters (such as systolic blood pressure <80 mmHg or heart rate <50 beats/minute lasting >1 hour despite fluid resuscitation).

Exclusion criteria

Contraindications for NPPV include:

• The need for urgent intubation.
• The need for frequent aspiration due to excessive secretions (more frequent than 15 min.).
• Inability of the patient to adapt himself / herself to the device or unwillingness to undergo NPPV.