The use of non-invasive mechanical ventilation (NIMV) in acute hypercapnic respiratory failure on COPD patients in the respiratory ward
D. Malamis, E. Tsarouha, A. Rapti, J. Giozos, J. Arapis, O. Anagnostopoulou (Athens, Greece)
Source: Annual Congress 2002 - Treatment and outcome of acute respiratory failure in chronic disease
Disease area: Airway diseases, Respiratory critical care
Abstract Background : Patients with COPD and acute hypercapnic Respiratory failure require frequently mechanical ventilation. Non-invasive mechanical ventilation (NIMV) has been used successfully in High Dependency Units, as an alternative to intubation and mechanical ventilation.The aim of our study was to assess the NIMV in a Respiratory ward. Method :19 patients with COPD and Hypercapnic Respiratory failure were included in the study. All of them were smokers. Inclusion criteria: PH [lte] 7.30, PaCO2 >= 65 mmHg and PaO2 [lte] 45 mmHg. NIMV was delivered through a nose mask with IPAP: 7-15 cmH2 O and EPAP: 3-5 cmH2 O. Exclusion criteria, coma: GCS [lte] 7 and systolic Hypotension, BP [lte] 90 mmHg. NIMV was added to standard medical treatment. Results : 3 of the 19 patients were intubated and mechanically ventilated. After 4 hours of continuous NIMV the PH and PaO2 of the remaining 16 patients improved significantly (PH: 7.26 ±] 0,13 to 7.33 ±] 0,22 p=0,00), (PaO2 : 46,5 ±] 3,6 to 56,1 ±] 3,1 p=0,048). Tachypnoea and alertness also improved. The PaCO2 was not significantly improved at 4h (PaCO2 : 88,2 ±] 4,3 to 80,6 ±] 4,3, p=0,10) but at 24 h (PaCO2 : 88,2 ±] 4,3 to 63,7 ±] 3,1, p=0,001). There were no late failures. Conclusions : NIMV is an effective treatment of COPD patients with acute hypercapnic respiratory failure in a respiratory ward. NIMV can be useful for avoiding intubation and mechanical ventilation. Best predictor of NIMV outcome is the improvement in PH, PaO2 and respiratory rate in the first 4 hours of ventilation.
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D. Malamis, E. Tsarouha, A. Rapti, J. Giozos, J. Arapis, O. Anagnostopoulou (Athens, Greece). The use of non-invasive mechanical ventilation (NIMV) in acute hypercapnic respiratory failure on COPD patients in the respiratory ward. Eur Respir J 2002; 20: Suppl. 38, 614
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