Use of the modified Glasgow Coma Scale score to guide sequential invasive‑noninvasive mechanical ventilation weaning in patients with AECOPD and respiratory failure

Abstract

Sequential invasive-noninvasive ventilation (NIV) improves the outcomes of patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, there is no clear consensus on the optimal timing of the switch to sequential invasive-NIV in these patients. In the present study, a potential role for the modified Glasgow Coma Scale (GCS) score to guide sequential weaning was investigated. Patients with AECOPD and respiratory failure were prospectively recruited from three study centers (Wenling Hospital Affiliated to Wenzhou Medical University, the First Affiliated Hospital of Wenzhou Medical University and Changsha Central Hospital) between January 1st 2016 and December 31st 2018. Patients were randomly assigned to group A and B, with the switching point for sequential weaning strategy in the two groups being a modified GCS score ≥13 and 10 points, respectively. Each group included 240 patients. Baseline demographic characteristics were comparable in the two groups. The duration of invasive mechanical ventilation (IMV) in group A was significantly shorter than that in group B. However, there were no significant between-group differences with respect to the incidence of re-intubation, ventilator-associated pneumonia, in-hospital mortality or the length of hospital stay. Use of a modified GCS score ≥13 as the switching point for sequential invasive-NIV may help decrease the duration of IMV in patients with AECOPD and respiratory failure.

Relationship between human serum albumin and in-hospital mortality in critical care patients with chronic obstructive pulmonary disease

“…Similar to the previous study and our clinical experience, we also found age ( 21 , 22 ), Glasgow score ( 23 ), respiratory rate ( 24 ), oxygen saturation ( 25 ), serum potassium, PCO 2 , peripheral vascular disease, renal disease, diabetes mellitus, comorbidity index ( 26 ), SOFA score ( 27 ) were also associated with in-hospital mortality.…”

Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

“…The results were in concurrence with the previous result. Excessive use of sedation and analgesia in the process of mechanical ventilation is the possible reason for delirium[ 22 ]. However, progressive early rehabilitation training mode was vital for patients rehabilitation training, especially when the patients were in disturbance of consciousness or ambiguity.…”

Agreement between two methods for assessment of maximal inspiratory pressure in patients weaning from mechanical ventilation

“…Therefore, the use of a unidirectional valve is indicated to measure the MIP. Discussion about the best protocol has continued, and although some authors consider 20 seconds to be long enough, others argue that 40 to 60 seconds of unidirectional valve occlusion are required for MIP measurement [ 9 , 17 ].…”

“…In addition to the patient demographics and diagnoses, level of consciousness was assessed using a modified GCS reported in other studies [ 16 , 17 ] to assess motor, eye, and verbal responsiveness. The previous studies reported that the verbal component of the GCS can be omitted (because the participants were on MV) without compromising the reliability of the score.…”