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Master Thesis

Efficacité et tolérance de la ventilation non invasive à fuite calibrée dans le traitement de l'acidose respiratoire en réanimation : étude "VNI Versus"

Abstract : Noninvasive ventilation (NIV) is a first-line therapy for acute respiratory failure with respiratory acidosis in the intensive care unit (ICU). There is no guideline concerning which kind of ventilator should be used in this setting. The aim of this study was to investigate whether a NIV-dedicated home ventilator (Resmed Stellar® 100), relying on a calibrated leak for exhalation, corrects more efficiently the hypercarbia responsible for respiratory acidosis, compared to an ICU ventilator (Dräger Evita® V500) functioning with an exhalation valve. In this prospective, cross-over study, patients were included if they had acute respiratory failure with marked hypercarbia (PaCO2 > 60 mmHg) and acidemia (pH < 7.36). In a random order, a first NIV session was applied with one kind of ventilator, followed by a 2-hour wash-out period. Then, a second NIV session was applied with the second kind of ventilator. Arterial blood gases were analyzed before and after each session. Fourteen patients were initially needed to reach statistical significance. After 4 years of recruitment, 7 patients were included, and 6 analyzed. During the first session, 2 patients received NIV through the home ventilator, and showed a decrease in PaCO2 of more than 20 mmHg; 4 patients received NIV through the ICU ventilator and only one showed a similar decrease in PaCO2. During the second session, only 2 patients showed persistent acidemia, and received NIV through the ICU ventilator. One of them showed a decrease in PaCO2 of more than 20 mmHg. Due to enrollment difficulties, this study cannot show any difference between a home ventilator and an ICU ventilator in the treatment of acute respiratory acidosis.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01876659
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Submitted on : Tuesday, September 18, 2018 - 4:03:12 PM
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Alexandre Godon. Efficacité et tolérance de la ventilation non invasive à fuite calibrée dans le traitement de l'acidose respiratoire en réanimation : étude "VNI Versus". Médecine humaine et pathologie. 2018. ⟨dumas-01876659⟩

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