Band 107, Heft 4

Background : Noninvasive positive-pressure ventilation (NPPV) is commonly used to improve ventilation and oxygenation in patients with acute respiratory failure (ARF). Mask leak and intolerance due to facial discomfort or claustrophobia often occur with NPPV and are frequently cited reasons for treatment failure. Methods : Retrospective review of patient records from a tertiary-care referral hospital. Results : We report the effectiveness of a full face mask in the application of NPPV for 10 nonambulatory patients (mean [SD], 61 [9] years) who had a combined total of 13 episodes of ARF. After these patients were unable to receive NPPV therapy via the more commonly available nasal or oronasal masks, care was provided using full face masks. Eight of 10 patients had hypercapnic respiratory failure; 2 patients, hypoxemic respiratory failure. All patients were placed on ventilation initially using a bi-level positive airway pressure device. Subsequently, patient ventilation was achieved using a Puritan Bennett 7200a ventilator for on-line respiratory monitoring. The mean (SD) duration of treatment with NPPV was 9.7 (2.7) hours per day for 3.0 (1.6) days. Following NPPV via full face mask, the patients' Pa co 2 decreased (65 [20] vs 82 [27] mm Hg, P =.09) and pH increased significantly (7.36 [0.07] vs 7.26 [0.07], P <.05) in less than 2 hours. Moreover, the patients demonstrated decreased respiratory rate (18 [7] vs 32 [8] breaths/min, P <.01), heart rate (106 [13] vs 124 [16] beats/min, P =.008), and Acute Physiology and Chronic Health Evaluation II scores (12 [3] vs 17 [4], P <.005) after NPPV via full face mask. These cardiorespiratory alterations occurred as early as 1 hour after NPPV initiation and were maintained throughout treatment. Two patients required endotracheal intubation because of copious purulent secretions. Conclusion : For individuals with hypercapnic respiratory failure who cannot tolerate NPPV using nasal or oronasal masks, use of full face masks may improve outcomes, allowing physicians to avoid ordering endotracheal intubation and mechanical ventilation.

Objective : To investigate the extent to which Medical College Admission Test (MCAT) subscores predict the overall academic performance of osteopathic medical students. Methods : We examined the value of MCAT subscores in predicting students' global academic performance in osteopathic medical school, as defined by grade point average in basic science (basic GPA), clinical instruction (clinical GPA), cumulative grade point average (total GPA), and national licensing examination scores on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2. Subjects were 434 osteopathic medical students of the Oklahoma State University College of Osteopathic Medicine in Tulsa who either graduated or were expected to graduate between the years 1999 and 2003. Standard, multivariate linear regression analyses were conducted for each of the five performance variables to assess the relative importance of MCAT subtest scores and cumulative undergraduate GPA (total UGPA) in predicting academic performance. Results : Total UGPA was the most important, significant predictor (β=.13-.33) in overall student academic performance for all five analyzed variables. Less predictive of overall academic performance (β=-.01-.21) were MCAT subcores. However, the MCAT biological sciences subscore was a significant predictor of basic GPA (β=.14), the MCAT physical sciences subscore significantly predicted COMLEX-USA Level 1 scores (β=.15), and the MCAT verbal reasoning subscore significantly predicted COMLEX-USA Level 2 scores (β=.21). The subscore for the MCAT writing sample was not a significant predictor of overall academic performance. Conclusion : Total undergraduate GPA had the highest predictive value for academic performance as measured by basic GPA, clinical GPA, total GPA, and COMLEX-USA Level 1 and Level 2 scores. The present study found MCAT subscores to be of limited predictive value in determining global academic performance.