Interface strategy during noninvasive positive pressure ventilation for hypercapnic acute respiratory failure

Crit Care Med. 2009 Jan;37(1):124-31. doi: 10.1097/CCM.0b013e3181928706.


Objective: To assess the influence of initial mask choice on the clinical effectiveness and tolerance of noninvasive positive pressure ventilation (NIPPV) in the management of hypercapnic acute respiratory failure.

Design: A prospective randomized controlled clinical study.

Setting: A medical intensive care unit at a university hospital.

Intervention: Randomization between two NIPPV interfaces.

Patients: Initial mask choice was randomized between two standard masks: face (NIPPVf group) and nasal (NIPPVn group). The main end point was mask failure (i.e., mask change and/or intubation). Secondary end points were tolerance of NIPPV, change in respiratory parameters during the first 3 days, and patient outcome. Results were analyzed on an intent to treat basis. A per protocol analysis was also conducted.

Main results: Ninety patients with underlying chronic lung disease were included, 46 in the NIPPVf group and 44 in the NIPPVn group. The overall success rate of NIPPV was 83%. Mask failure occurred significantly more often in the NIPPVn group (32/44 vs. 9/46; p < 0.0001), mainly because of the need for mask change (32/44 vs. 0/46; p < 0.0001) because of the occurrence of major buccal air-leaks in 94% of cases. Improvement in respiratory parameters was similar in the two groups. Whereas air-leaks were more frequent in the NIPPVn group (p < 0.05), respiratory comfort was assessed as lower and complications more frequent by the staff in the NIPPVf group from day 2 (p < 0.05).

Conclusions: A face mask should be the first-line strategy in the initial management of hypercapnic acute respiratory failure with NIPPV. However, if NIPPV has to be prolonged, switching to a nasal mask may improve comfort by reducing face mask complications.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Hypercapnia / complications*
  • Hypercapnia / therapy*
  • Intubation, Intratracheal*
  • Laryngeal Masks*
  • Male
  • Middle Aged
  • Positive-Pressure Respiration / methods*
  • Respiratory Insufficiency / complications*
  • Respiratory Insufficiency / therapy*