Predictors of Outcome in COPD Patients with Hypercapnic Respiratory Failure Requiring NIV
Journal Title: Enliven: Journal of Anesthesiology and Critical Care Medicine - Year 2014, Vol 1, Issue 2
Abstract
Background and Objectives: Delay in identifying patients in whom NIV will be unsuccessful may postpone endotracheal intubation, increasing morbidity and mortality. Aim of this study was to determine factors associated with NIV failure in patients with COPD exacerbations. Methods: We retrospectively evaluated COPD patients with acute respiratory failure due to an acute exacerbation, undergoing NIV for at least 12 hours. Univariable analysis was performed on: age, gender, APACHE II, GCS, gas exchange at admission, during NIV and at discharge/death, length of stay. A ROC curve for the variable pH START (arterial pH value at admission) was performed and sensitivity,specificity, likelihood ratios and confidence intervals, were calculated. Results: Among 201 enrolled individuals, NIV failed in 50 subjects, leading to invasive ventilation and/or death. NIV succeeded in patients with: lower APACHE II (20.02±4.81 in succeeding group vs 24.84±6.35 in failing group, p<0.001) and PaCO2 at admission (93.10±15.08 vs 98.45±16.09, respectively, p=0.029) and after 2-4 hours of NIV (77.62±13.62 vs 82.12±15.24, respectively, p=0.044), and higher pH at admission (7.26±0.06 vs 7.23±0.08, respectively, p=0.033), and GCS (12.94±2.44 vs 11.24±3.32, respectively, p=0.001). No variable was found to be able to predict NIV failure in patients with pH START >7.20 and ≤7.25, despite the high percentage of successes observed in this subset of individuals (81%). Conclusion: Further multicentric studies are needed to better define NIV indications, with special reference to pH thresholds.
Authors and Affiliations
Paone Gregorino, Terzano Claudio, Mollica Corrado, Sebastiani Alfredo, Mannocci Alice, Puglisi Giovanni
Keywords
Related Articles
- EP ID EP618256
- DOI -
- Views 210
- Downloads 0
Renal Artery Stenosis in Patients Undergoing Major Surgery or otherwise Critically Ill: The Short-Circuit between Association and Causality
Risk prediction is an intense field of research and there is an increasing need for an interest in being able to empirically estimate customized, patient-specific risks for virtually all surgical operations in a user fri...
The Effect of Preemptive Oral Celecoxib on Pain Reduction and Opioid Consumption during Elective Herniorrhaphy
Introduction Pain control is an important aspect in postoperative care. While opioids proved excellent analgesia undesirable side effects such as respiratory depression, nausea and vomiting, constitute major limitation....
Ultrasound guided Transverses Abdominal Plane Block versus Ilioinguinal/iliohypogastric Nerve Blocks for Postoperative Analgesia in Children Undergoing Lower Abdominal Surgery
Background Pediatric patients undergo a variety of lower abdominalsurgical procedures that need adequate pain relief perioperatively. Ultrasound guided lioinguinal/iliohypogastric nerve blockade and TAB block are common...
Magnesium on Blockage of Nuclear Factor-B Activation at Ventilator-Induced Lung Injury: Random Trial
Rationale The mechanical ventilation may aggravate the severe acute lung injury and trigger a systemic inflammatory response. The pathophysiology evolves Biotrauma, meaning that the over distension and the cyclical openi...
A Complication of Tracheaesophageal Fistula Treatment with Glue: Endotracheal Cuff Adhesion
The repair of tracheoesophageal fistula (TEF) requires an important surgical process, surgical ligation of the fistula with a cervical or thorasic approach. Surgical treatment is associated with high morbidity and mortal...