In some patients with acute respiratory insufficiency (M.e,d..U..r.i,...e.t.,.a./: 1989), mask CPAP therapy has been used as the sole mode of ventilatory support (Fig 1). This type of therapy is also effective in some trauma patients presenting with hypoxemia, thereby avoiding endotracheal intubation. Furthermore, spontaneous breathing through a CPAP face mask results in a better Pao2 after coronary artery bypass surgery. CPAP applied to patients presenting with postextubation hypoxemia persisting after chest physiotherapy can also be treated satisfactorily with CPAP alone at a level of 5 to 10 cmH 2O. Carbon dioxide retention producing hypercarbia can be seen during mask CPAP ventilation and has been regarded as a relative contraindication to its use. This should not prevent a therapeutic trial. However, this is acceptable only in situations where adequate staffing and capability to measure arterial blood gases are available so that these patients can be monitored very closely. Indeed, non-invasive ventilatory support requires very close supervision by intensive care unit staff; perhaps more than in tracheally intubated patients.
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