ABSTRACT 
Nº 00186MT

PAINEL DE DISCUSSÃO

DÍA 6 A 13 DE DICIEMBRE DE 1.999
DECEMBER 6- 13, 1999
DIA 6 PARA 13 de DEZEMBRO de 1999

TITLE

NON-INVASIVE VENTILATION WITH PRESSURE CONTROLLED VENTILATION IN A PATIENT WITH ACUTE RESPIRATORY FAILURE

Miguel Tavares, Fernando Rua

Serviço de Cuidados Intensivos, Hospital Geral de Santo António. PORTO. PORTUGAL
 

INTRODUCTION: 
There has been recently an increased interest in the use of non-invasive positive-pressure ventilation (NIV) in the management of acute respiratory failure. NIV with nasal or face mask improves gas exchange, decreases respiratory rate, allows patients to talk and take medications orally and may reduce the need for invasive mechanical ventilation while the underlying disease is being treated. NIV proved to be feasible and appropriate for the treatment of respiratory failure in patients who were at high risk of intubation-related complications 1,2.
We report a case of Pressure-Controlled Ventilation (PCV) through a tightly fitting nasal mask in a patient with severe acute hypoxemic respiratory failure after liver transplant.

CASE REPORT: 
A 34-year-old male suffering from Familial Amiloid Polineuropathy (FAP) underwent liver transplant. Discharged from ICU the following day after a normal post-operative course. Readmitted to ICU two days later with severe hypoxemic respiratory failure unresponsive to increasing levels of FiO2 with bilateral diffuse infiltrates and PaO2/FiO2 ratio of 46,2.
Pressure-Controlled Ventilation through a tightly fitting nasal mask with a Siemens Servo 300 ventilator was initiated. During two days the patient tolerated the nasal mask very well, improving gas exchange under continuous PCV, with increasing levels of PEEP till a measured PEEP of 10 cm H2O, avoiding intubation. Doppler done before admission showed normal hepatic graft artery flow, but two days later, hepatic angiography demonstrated arterial thrombosis and the patient underwent hepatic artery bypass.
Came back from operating room with endotracheal tube, had a normal post-operative course and was discharged 3 days later with cleared lungs.

CONCLUSION: 
Pressure-Controlled Ventilation (PCV) through a tightly fitting nasal or facemask in a controlled environment may offer a therapeutic alternative in selected patients with acute respiratory failure after liver transplant.

REFERENCES
1. Intensive Care Med 1998 Dec; 24 (12): 1283-8 Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Conti G, Marino P, Cogliati A, Dell'Utri D, Lappa A, Rosa G, Gasparetto A 
2. Bone Marrow Transplant 1998 May; 21 (10): 1067-9. Successful management of adult respiratory distress syndrome (ARDS) after high-dose chemotherapy and peripheral blood progenitor cell rescue by non-invasive ventilatory support. Rabitsch W, Staudinger T, Brugger SA, Reiter E, Keil F, Herold C, Lechner K, Greinix HT, Kalhs P