Predictors of Outcome in COPD Patients with Hypercapnic Respiratory Failure Requiring NIV

Conti, Vittoria; Terzano, Claudio; Mollica, Corrado; Sebastiani, Alfredo; Mannocci, Alice; Torre, Giuseppe La; Brunetti, Giuseppe; Monaco, Gianluca; Puglisi, Giovanni

doi:10.18650/2374-4448.12004

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Unfortunately, analysis of studies led to inconclusive results. 39,40 In this context, we made a comparison of some parameters between the groups, respectively, with success or failure of NIV. Since acidosis is one of main indicators of severity of ARF, whose greater worsening may indicate higher probability of failure of NIV, 41,42 we looked for a possible difference in success rate of NIV in our patients according to severity of acidosis at admission (pH<7.25 vs pH>7.25).…”

Section: Discussionmentioning

confidence: 99%

Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

Ventrella¹,

Giancola²,

Cappello³

et al. 2015

Ital J Med

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Controlled trials demonstrated efficacy and safety of non-invasive ventilation (NIV) in treatment of acute respiratory failure, initially in Intensive Care Units, then in other care settings (semi-intensive care units, emergency departments, and also in the wards, more often pneumological ones). Few studies have been published about NIV in Italian wards of Internal Medicine with full self-management of NIV by internists in a normal ward setting. We performed a prospective real-life study about the use of NIV in Internal Medicine ward devoid of a critical area of semi-intensive therapy, with the aim of confirming, in this setting, the effectiveness of NIV. During a period of 13 months, 42 patients with hypercapnic respiratory failure of different etiology and acidosis (pH<7.35) were treated by NIV. NIV was successful in 81% of patients. In-hospital mortality was 9.5%. Safety of NIV is demonstrated by the absence of serious complications: only 7 patients showed poor compliance and 2 patients had facial pressure ulcer due to the mask. There were not statistical differences in success rate of NIV according to severity of acidosis at admission (pH<7.25 vs pH>7.25), neither according to the acute physiology and chronic health evaluation II score and the national early warning score, but the modified early warning score only showed statistically significant difference with lower values in the success group: 2.82±1.57 vs 4.13±1.46 (P<0.05). NIV has proven to be effective and safe in Internal Medicine ward.

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Section: Discussionmentioning

confidence: 99%

Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

Ventrella¹,

Giancola²,

Cappello³

et al. 2015

Ital J Med

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“…This could be because the infective group was more likely to have a more severe illness. 15 The main limitation of the study was that it was a single centre study. Another limitation of this study was its small sample size and lack of control group.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of non-invasive ventilation in patients with type 2 respiratory failure

et al. 2021

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Background: Assess the use of non-invasive ventilation as an alternative way for ventilation in acute respiratory failure, determine factors that can predict the successful use of NIV, evaluate factors hindering success of NIV.Methods: Thirty hospitalised patients fulfilling inclusion criteria, diagnosed with Type II Respiratory Failure on ABG were recruited after obtaining an informed written consent. Complete history and detailed physical examination were followed by routine investigations.Results: Comparison of the pH on admission with the pH after 1st hour of NIV, the latter showed statistically significant improvement. Drop in PaCo2 and rise in PaO2 on ABG from admission and after stopping NIV was statistically significant. Patients with lower MMRC grade and severe cough showed significant improvement in pH, however patient with higher emergency visits and past hospitalisation showed less improvement in pH, after 1 hour of NIV therapy. A total 4 patients were intubated, with mean pH of 7.22, 3 out of them had higher emergency visits, 2 out of them had ICU admission.Conclusions: NIV treatment for COPD with type II respiratory failure avoids intubation, reduces complications and should be considered as first line therapy instead of ET intubation. Lower mMRC grade, lesser hospitalizations, lesser emergency visits, higher BMI, symptoms like cough, can have a positive predictive value for the outcome of NIV.

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“…Other studies reported failure rates from 10-30% with BiPAP and pressure support modes using both nasal and facial masks with a significant proportion of them being late failures in patients who might have responded to NIV favourably initially. 9,14,15,16 Mortality in patients requiring invasive ventilation is high. The mortality rate in our study for patients requiring invasive ventilation is 53.8%, which is comparable to the mortality of 52.9% reported by Uegun et al 4 However, Epstein et al 17 reported a mortality of 28% in patients requiring invasive ventilation.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients Admitted to the Ccu (Critical Care Unit) of a Tertiary Care Hospital With Acute Exacerbation of Copd and Respiratory Failure

Vaidyanathan¹,

Bangarpet²

2015

jemds

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AIMTo study the outcome and predictors affecting the mortality in COPD patients with acute exacerbation and respiratory failure following pharmacotherapy, non-invasive ventilation and invasive ventilation. MATERIAL AND METHODSForty patients with acute exacerbation of COPD admitted to the CCU for one year period were studied. Baseline clinical assessment, investigations, APACHE II, APACHE III and OSF scorings were done. RESULTSOut of 40 patients 24 responded to pharmacotherapy, of these 2 patients died due to other causes. Five patients were initiated on non-invasive ventilation of which 2 patient's required invasive ventilation. Remaining 11 patients required invasive ventilation on admission, of these 7 patients died. Mortality was 43.75%. Multivariate analysis was done and APACHE II and Alveolar-arterial oxygen gradient (A-a) DO2 were independent predictors of mortality. CONCLUSIONAlthough significantly high mortality was seen in mechanically ventilated patients (43.75%), the overall mortality in this study was 22.5% and hence it can be concluded that the results of aggressive treatment of acute respiratory failure in COPD patients is favourable.

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Predictors of Outcome in COPD Patients with Hypercapnic Respiratory Failure Requiring NIV

Cited by 8 publications

References 26 publications

Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

Effectiveness of non-invasive ventilation in patients with type 2 respiratory failure

Outcome of Patients Admitted to the Ccu (Critical Care Unit) of a Tertiary Care Hospital With Acute Exacerbation of Copd and Respiratory Failure

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