Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure

Confalonieri, Marco; Parigi, Piercarlo; Scartabellati, Alessandro; Aiolfi, S; Scorsetti, S.; Nava, Stefano; Gandola, Lorenza

doi:10.1183/09031936.96.09030422

Cited by 107 publications

(66 citation statements)

References 37 publications

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“…The duration of invasive mechanical ventilation was 13±6 days (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in the 4 patients in the treatment group who required reintubation and who had favourable outcomes. In the surviving patients, the total time of ventilatory assistance for the treatment of the postextubation distress (duration of NIPSV in all patients in the treatment group, and duration of invasive mechanical ventilation performed after reintubation in patients in both groups who required reintubation) was 6±4 days (range, 2-21) in the treatment group compared with 11±8 days (range, 5-25) in the control group (p<0.01).…”

Section: Clinical Studymentioning

confidence: 99%

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Hilbert¹,

Gruson²,

Portel³

et al. 1998

Eur Respir J

199

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Patients with chronic obstructive pulmonary disease (COPD) who have been intubated and mechanically ventilated may prove difficult to wean. Noninvasive ventilation may be used in an attempt to avoid new endotracheal intubation. The efficacy of administration of noninvasive pressure support ventilation was evaluated in 30 COPD patients with postextubation hypercapnic respiratory insufficiency, compared with 30 historically matched control patients who were treated conventionally. Patients were included in the study if, within 72 h postextubation, they presented with respiratory distress, defined as the combination of a respiratory frequency >25 breaths x min(-1), an increase in the arterial carbon dioxide tension (Pa,CO2) of at least 20% compared with the value measured after extubation, and a pH <7.35. Noninvasive pressure support ventilation was effective in correcting gas exchange abnormalities. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation: 20 of the 30 patients (67%) in the control group required endotracheal intubation, compared with only six of the 30 patients (20%) in the noninvasive-ventilation group (p<0.001). In-hospital mortality was not significantly different between the two groups, but the mean duration of ventilatory assistance for the treatment of the postextubation distress, and the length of intensive care unit stay related to this event, were both significantly shortened by noninvasive ventilation (p<0.01). In conclusion, noninvasive ventilation may be used in the management of patients with chronic obstructive pulmonary disease and postextubation hypercapnic respiratory insufficiency.

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Section: Clinical Studymentioning

confidence: 99%

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Hilbert¹,

Gruson²,

Portel³

et al. 1998

Eur Respir J

199

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“…In the study of BOTT et al [4], NIPSV was used for 6 days, as for patients in group I in the present study; however, respiratory acidosis was more significant for patients in the present study than in that of BOTT et al [4]. Some authors have previously proposed administering NIPSV discontinuously [1,4,5,20,23,24]. The sequential mode used on the present study is also a discontinuous mode, thus allowing comparison of the present results with those of other studies, with some specificity, i.e.…”

Section: Discussionmentioning

confidence: 50%

“…4 days. Conversely, in the study of CON-FALONIERI et al [20], the patients were ventilated for 9.8 days, despite the fact that the technique was used continually. In the study of BOTT et al [4], NIPSV was used for 6 days, as for patients in group I in the present study; however, respiratory acidosis was more significant for patients in the present study than in that of BOTT et al [4].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

et al. 2000

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Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit.During the first 24 h after enrolment, NIPSV was used for 6.7 3.2 h (mean SD) in group I and 5.6 3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47 12 and 11 7 min in group I, and 46 12 and 11 6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7 3.2 h . day -1 in group I and 4.9 3.5 h . day -1 in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44 10 and 7 4 min in group I, and 47 14 and 7 3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients.In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency. Methods of noninvasive pressure support ventilation (NIPSV) are being proposed more and more for patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure [1±6]. NIPSV can avoid the need for endotracheal intubation and its increasingly documented complications [7]. Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2, 4, 9, 10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].Three articles have demonstrated that the institution of noninvasive mechanical ventilation is not significantly more time-consuming for personnel than traditional medical therapy [4,12] or invasive mechanical ventilation [13]. However, two of these studies [12,13] were performed in respiratory intensive care units (ICUs) with a specialized activity, and where patient/staff ratios are generally lower than in general ICUs [13]. The authors consider that the problem lies not in comparing the workload linked to utilization of NIPSV with that linked to standard treatment or invasive mechanical ventilation, since it is advisable to use NIPSV to avoid intubation. It is more a question of know...

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“…Acidosis is associated with increase mortality and also a higher need for intubation.2 3 Noninvasive ventilation (NIV) using a face or nasal mask has been shown in randomized controlled trials to reduce the need for subsequent intubation and mortality in this group of patients.4-6 Two cohort studies have also reported a long term survival advantage [19,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Total admission rates fall in the summer but the rate of respiratory acidosis was more constant at 18 per month (range [10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Variability In Admission Rates Within and Between Yearsmentioning

confidence: 99%

One and half year prevalence study of respiratory acidosis in acute exacerbation of chronic obstructive pulmonary disorders

Mane¹

2016

SJAMS

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Abstract:Maintenance of acid-base homeostasis is a vital function of the living organism. Deviations of systemic acidity in either direction can impose adverse consequences and when severe can threaten life itself. The present study was done to assess the prevalence rate of the respiratory acidosis among the admitted patients of SMBT medical college and hospital, Ghoti, Nasik. One and half year prospective prevalence study was carried out at SMBT medical college, Ghoti, Nasik. Patients were identified with a respiratory diagnosis or symptoms from the hospital by the two expert researchers. Patients were of the age group of 40 to 75 years. Age, sex, date of admission, and the first arterial blood gas tension were recorded. The date of discharge, intensive care (ICU), use and in hospital mortality were obtained retrospectively from the hospital patient administration system and the ICU computer databases in combination with note retrieval. Statistical analysis was performed with the help of IBM SPSS statistics version 20. All patients admitted are assessed and the details were recorded. Total of 1001 patients were admitted for the complaint of COPD or asthma. Out of these 172 patients (17.18%) had developed respiratory acidosis. There is need to develop the various preventive strategies to control the development of the respiratory acidosis.

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Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure

Cited by 107 publications

References 37 publications

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

One and half year prevalence study of respiratory acidosis in acute exacerbation of chronic obstructive pulmonary disorders

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