[Non-invasive positive pressure respiration in acute respiratory failure caused by suicidal oral intoxication with morphine sulphate]

Abstract

In this article we described a 15-year-old female who was admitted to the Clinic of Toxicology because of suicidal, oral intoxication with morphine sulphate in the total dosage of 360 mg. In the Clinic the patient was in I degree degree of Matthew coma scale, with the heart rate about 90/min., blood pressure 105-100/70-60 mmHg, breath rate about 7/min. The arterial blood gas analysis showed acute respiratory failure (pCO2 64.1 mmHg, pO2 54.9 mmHg and SO2 88%) in spite of constant and intravenous Naloxone infusion. The mother of the patient, who was a nurse, had not agreed to endotracheal intubation and invasive method of respiration. Because of that reason the non invasive positive pressure ventilation with the BiPAP Synchrony apparatus were used with IPAP 14 cm H2O, EPAP 5 cm H2O, breath rate 12/min, time of inspiration 2.0 sek., time of inspiration grow 600 msek. After 15 minutes of respiration pCO2 decreased up to 40 mmHg, pO2 increased up to 73.3 mmHg and the oxygen saturation of arterial blood was 95.7-98.6%. Respiratory failure was observed every time when apparatus was withdrawn. After 24 hours of ventilation by BiPAP Synchrony apparatus the full stabilization of respiratory tract was achieved.