ISSN:
1432-1238
Keywords:
Key words Chronic obstructive pulmonary disease
;
Intermittent positive pressure ventilation
;
Noninvasive ventilation
;
Respiratory acidosis
;
Respiratory failure
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objectives: To compare the efficacy of noninvasive pressure support ventilation (NIPSV) in acute decompensation in chronic obstructive pulmonary disease (COPD) by means of a bi-level positive airway pressure support system (BiPAP) in a sequential mode with medical therapy alone; to assess the short-term physiologic effects of the device on gas exchange; and to compare patients successfully ventilated with NIPSV with those in whom NIPSV failed. Design: A prospective case series with historically matched control study. Setting: A general intensive care unit (ICU) of a university hospital. Patients: We evaluated the efficacy of administration of NIPSV in 42 COPD patients and compared this with standard treatment in 42 matched historical control COPD patients. Interventions: NIPSV was performed in a sequential mode, i. e., BiPAP in the spontaneous mode was used for at least 30 min every 3 h. Between periods of ventilation, patients could be systematically returned to BiPAP when the arterial oxygen saturation was 〈 0.85 or when the respiratory rate was 〉 30 breaths/min. Measurements and results: Success rate, mortality, duration of ventilatory assistance, and length of ICU stay were recorded. Eleven of the 42 patients (26 %) in the NIPSV group needed tracheal intubation compared with 30 of the 42 control patients (71 %). The 31 patients in whom NIPSV was successful were ventilated for a mean of 6 ± 3 days. In-hospital mortality was not significantly different in the treated versus the control group, but the duration of ventilatory assistance (7 ± 4 days vs 15 ± 10 days, p 〈 0.01) and the length of ICU stay (9 ± 4 days vs 21 ± 12, p 〈 0.01) were both shortened by NIPSV. BiPAP was effective in correcting gas exchange abnormalities. The pH values, measured after 45 min of BiPAP with optimal settings, in the success (7.38 ± 0.04) and failure (7.28 ± 0.04) patients were significantly different (p 〈 0.05). Conclusions: NIPSV, performed with a sequential mode, may be used in the management of patients with acute exacerbations of COPD.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001340050438
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