TY - JOUR
T1 - Noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and severe hypercapnic neurological deterioration in the emergency room
AU - Briones Claudett, Killen Harold
AU - Briones Claudett, Mónica H.
AU - Chung Sang Wong, Miguel A.
AU - Andrade, Michelle Grunauer
AU - Cruz, Cristhian X.
AU - Esquinas, Antonio
AU - Diaz, Gumersindo Gonzalez
PY - 2008/6
Y1 - 2008/6
N2 - OBJECTIVES: The objective of this study was to assess the effectiveness of noninvasive motion ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD), having infectious exacerbation and severe hypercapnic neurological dysfunction in the emergency room. DESIGN: This is a prospective interventional study. SETTING: The study setting was the emergency room at the Military Hospital in Guayaquil, Ecuador. PATIENTS: A total of 24 patients were studied. Twelve patients had acute exacerbation of their chronic obstructive pulmonary disease: they presented at the emergency room with severe neurological dysfunction, with a Glasgow Coma Scale (GCS) score of less than 8 and a pH of less than 7.25. These patients were compared with 12 controls who were being treated with invasive mechanical ventilation (IMV), who were then matched according to their GCS scores, pH status, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and age. INTERVENTIONS: We evaluated the effectiveness and safety of applying a ventilatory strategy based on a biphasic positive airway pressure protocol in the emergency room. MEASUREMENTS AND RESULTS: The pH, PCO2, and GCS scores, measured during the first 3 h, were predictors of success for the application of NIMV treatment (P<0.05). Mortality was 33.3 and 16.7% for the IMV and the NIMV groups, respectively (P=0.01). Days of IMV were 5.60±1.2 versus 3.6±1.1 for NIMV (P=0.006). Days of hospitalization were 11.1±4.7 for the IMV group and 6.5±1.9 for the NIMV group (P=0.001). The cumulative survival rates at 6 months were 71.4 and 80% for the IMV and NIMV groups, respectively (P=0.80). CONCLUSION: We consider that severe neurological dysfunction and pH of less than 7.25 do not constitute absolute contraindications to the use of NIMV. This kind of management can be implemented in the emergency room with favorable results.
AB - OBJECTIVES: The objective of this study was to assess the effectiveness of noninvasive motion ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD), having infectious exacerbation and severe hypercapnic neurological dysfunction in the emergency room. DESIGN: This is a prospective interventional study. SETTING: The study setting was the emergency room at the Military Hospital in Guayaquil, Ecuador. PATIENTS: A total of 24 patients were studied. Twelve patients had acute exacerbation of their chronic obstructive pulmonary disease: they presented at the emergency room with severe neurological dysfunction, with a Glasgow Coma Scale (GCS) score of less than 8 and a pH of less than 7.25. These patients were compared with 12 controls who were being treated with invasive mechanical ventilation (IMV), who were then matched according to their GCS scores, pH status, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and age. INTERVENTIONS: We evaluated the effectiveness and safety of applying a ventilatory strategy based on a biphasic positive airway pressure protocol in the emergency room. MEASUREMENTS AND RESULTS: The pH, PCO2, and GCS scores, measured during the first 3 h, were predictors of success for the application of NIMV treatment (P<0.05). Mortality was 33.3 and 16.7% for the IMV and the NIMV groups, respectively (P=0.01). Days of IMV were 5.60±1.2 versus 3.6±1.1 for NIMV (P=0.006). Days of hospitalization were 11.1±4.7 for the IMV group and 6.5±1.9 for the NIMV group (P=0.001). The cumulative survival rates at 6 months were 71.4 and 80% for the IMV and NIMV groups, respectively (P=0.80). CONCLUSION: We consider that severe neurological dysfunction and pH of less than 7.25 do not constitute absolute contraindications to the use of NIMV. This kind of management can be implemented in the emergency room with favorable results.
KW - Bilevel positive airway pressure
KW - Chronic obstructive pulmonary disease
KW - Noninvasive mechanical ventilation
KW - Severe hypercapnic neurological dysfunction
UR - http://www.scopus.com/inward/record.url?scp=43149093974&partnerID=8YFLogxK
U2 - 10.1097/MEJ.0b013e3282f08d08
DO - 10.1097/MEJ.0b013e3282f08d08
M3 - Artículo
C2 - 18460951
AN - SCOPUS:43149093974
SN - 0969-9546
VL - 15
SP - 127
EP - 133
JO - European Journal of Emergency Medicine
JF - European Journal of Emergency Medicine
IS - 3
ER -