Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units

BMC Pulmonary Medicine

Research Article

Enric Prats¹  Eva Farrero¹  Francisco Rodríguez-Jerez²  Ramón Fernández-Álvarez²  José J. Cebrian³  Juan A. Piña³  Pedro Benavides⁴  Javier Sayas⁴  Cristóbal Esteban⁵  Myriam Aburto⁵  M. A. Gómez-Mendieta⁶  Ana Santiago-Recuerda⁶  Enrique Zamora⁷  Gonzalo Segrelles⁷  Ángel Ortega-González⁸  José C. Serrano-Rebollo⁸  Javier Gomez de Terreros⁹  M. Jesus Martin-Vicente⁹  Juan F. Masa⁹  Isabel Utrabo⁹  Antonio Antón^1,10  Patricia Peñacoba^1,10  Alicia Binimelis^1,11  Belén Núñez^1,11  Ernest Sala^1,11  Francisco J. Rivas^1,12  Carlos J. Egea^1,12  Lidia Méndez^1,13  Emilia Barrot^1,14  Luis Jara-Palomares^1,14  Raquel Sánchez-Oro-Gomez^1,14  Raquel Català^1,15 

[1] Belvitge Hospital, Barcelona, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Central de Asturias Hospital, Oviedo, Spain;Costa del Sol Hospital, Málaga, Spain;Doce de Octubre Hospital, Madrid, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Galdakao-Usansolo Hospital, Bilbao, Spain;La Paz Hospital, Madrid, Spain;La Princesa Hospital, Madrid, Spain;Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain;San Pedro de Alcántara Hospital, C/Rafael Alberti 12, 10005, Cáceres, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Sant Pau Hospital, Barcelona, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Son Espases Hospital, Palma de Mallorca, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Txaguritxu Hospital, Vitoria, Spain;CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Universitario Lucus Augusti Hospital, Lugo, Spain;Virgen del Rocío Hospital, Sevilla, Spain;“Sant Joan” University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Tarragona, Spain;

关键词: Noninvasive ventilation;    Respiratory intermediate care unit;    Acute hypercapnic respiratory failure;    COPD;    Acute pulmonary edema;    Obesity hypoventilation syndrome;   

DOI  :  10.1186/s12890-016-0262-9

 received in 2015-11-11, accepted in 2016-06-11,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundSevere acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS.MethodsWe prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure.ResultsWe included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups.ConclusionsACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.

【 授权许可】

CC BY   
© The Author(s). 2016