Weaning from Mechanical Ventilation by Long-Term Nasal Positive Pressure Ventilation in Two Patients with Acute Respiratory Distress Syndrome Associated with Pneumococcal Sepsis

• Published in: Respiration Vol. 69; no. 5; pp. 464 - 467
• Main Authors: Windisch, Wolfram, Storre, Jan Hendrik, Matthys, Heinrich, Sorichter, Stephan, Virchow Jr, Johann Christian
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 2002; S. Karger AG
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Case Report; Emergency and intensive respiratory care; Female; Humans; Intensive care medicine; Masks; Medical sciences; Middle Aged; Pneumonia, Pneumococcal - physiopathology; Pneumonia, Pneumococcal - therapy; Positive-Pressure Respiration - methods; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - therapy; Streptococcus pneumoniae; Time Factors; Treatment Outcome; Ventilator Weaning - methods; Acute respiratory distress syndrome; Noninvasive positive pressure ventilation; Weaning; Human; Lung disease; Pneumonia; Respiratory disease; Acute; Long term; Infection; Case study; Concomitant disease; Positive pressure; Streptococcal infection; Bacteriosis; Respiratory distress; Technique; Pneumococcal infection; Mechanical ventilation
• ISSN: 0025-7931; 1423-0356
• DOI: 10.1159/000064011

Only few data concerning weaning by nasal positive pressure ventilation (NPPV) are available, and successful weaning by using NPPV in patients with acute respiratory distress syndrome (ARDS) and severe complications has not yet been described. Two cases with ARDS and both preexisting thoracopulmonary disease (infundibulum abnormality and suspected COPD) and associated complications (recurrent sepsis, acute renal failure, need for lobectomy, severe malnutrition) could not be weaned by invasive ventilatory techniques. Both patients presented with rapid shallow breathing and PaCO 2 values >60 mm Hg during intermittent trials of spontaneous breathing, although the primary pathology and associated complications had been resolved. Patients were successfully adapted on NPPV in a stepwise approach after 93 days and 67 days of invasive ventilation. In one patient withdrawal from NPPV was possible after 2 months. In the other patient the duration of daily ventilation could be significantly reduced from 18 to 6 h/day after 9 months on NPPV. Therefore, patients with ARDS who cannot be weaned by invasive ventilatory strategies might be removed successfully from invasive mechanical ventilation by using NPPV even when there are preexisting thoracopulmonary disease and major complications during invasive ventilation.