Hyogo College of Medicine, Japan
Takeshi Nishimura was graduated from Okayama University in Japan in 2009. He was trained for 5 years as Surgical Clinician and has worked as Emergency Clinician for two years. He is specialized with traumatology and gastroenterology. He has published more than 5 papers in journal about emergency medicine and emergency surgery.
Non-invasive positive pressure ventilation (NIPPV) is widely used in patients with respiratory failure due to neuromuscular disease. NIPPV is safe and effective device that might be able to avoid potential complications associated with invasive mechanical ventilation such as nosocomial pneumonia and tracheal trauma. NIPPV can be used intermittently, the equipment is portable and ventilation does not interfere with eating and speaking. The most frequent trouble that might occur is ulcer at face in fitting mask. However, time consuming, some lethal complications associated with NIPPV had been reported in recent years. A 23 year old man was admitted to our hospital complaining of severe abdominal pain. He has a history of congenital hypomyelination neuropathy. Because of respiratory trouble due to neuropathy, doctor had prescribed NIPPV and increased end respiratory pressure before five days. Abdominal computed tomography revealed free intra-abdominal air leading to emerging laparotomy. Intra operative findings showed a gastric perforation and hematoma at gastric anterior walls. Patient recovered after obstructive bowel obstruction and transferred to pediatrics post admission on Day 26. Previous study associating with complications of gastrointestinal perforation has rarely been reported ever. We emergent clinicians should be aware of these complications. NIPPV is not always non-invasive equipment. Acknowledgement of prevention and recognition related to complications with NIPPV leads appropriate use of it depends on patient’s condition.