Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
Por:
Masa, JF, Utrabo, I, de Terreros, JG, Aburto, M, Esteban, C, Prats, E, Nunez, B, Ortega-Gonzalez, A, Jara-Palomares, L, Martin-Vicente, MJ, Farrero, E, Binimelis, A, Sala, E, Serrano-Rebollo, JC, Barrot, E, Sanchez-Oro-Gomez, R, Fernandez-Alvarez, R, Rodriguez-Jerez, F, Sayas, J, Benavides, P, Catala, R, Rivas, FJ, Egea, CJ, Anton, A, Penacoba, P, Santiago-Recuerda, A, Gomez-Mendieta, MA, Mendez, L, Cebrian, JJ, Pina, JA, Zamora, E, Segrelles, G
Publicada:
7 jul 2016
Resumen:
Background: Severe 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.
Methods: We 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. (Continued on next page)
Results: We 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.
Conclusions: ACPE, 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.
Filiaciones:
Masa, JF:
San Pedro de Alcantara Hosp, C Rafael Alberti 12, Caceres 10005, Spain
CIBER Enfermedades Resp, Madrid, Spain
Utrabo, I:
San Pedro de Alcantara Hosp, C Rafael Alberti 12, Caceres 10005, Spain
CIBER Enfermedades Resp, Madrid, Spain
de Terreros, JG:
San Pedro de Alcantara Hosp, C Rafael Alberti 12, Caceres 10005, Spain
CIBER Enfermedades Resp, Madrid, Spain
Aburto, M:
Galdakao Usansolo Hosp, Bilbao, Spain
Esteban, C:
Galdakao Usansolo Hosp, Bilbao, Spain
Prats, E:
Belvitge Hosp, Barcelona, Spain
CIBER Enfermedades Resp, Madrid, Spain
Nunez, B:
Son Espases Hosp, Palma De Mallorca, Spain
CIBER Enfermedades Resp, Madrid, Spain
Ortega-Gonzalez, A:
Nuestra Senora del Prado Hosp, Toledo, Spain
Jara-Palomares, L:
Virgen del Rocio Hosp, Seville, Spain
Martin-Vicente, MJ:
San Pedro de Alcantara Hosp, C Rafael Alberti 12, Caceres 10005, Spain
CIBER Enfermedades Resp, Madrid, Spain
Farrero, E:
Belvitge Hosp, Barcelona, Spain
CIBER Enfermedades Resp, Madrid, Spain
Binimelis, A:
Son Espases Hosp, Palma De Mallorca, Spain
CIBER Enfermedades Resp, Madrid, Spain
Sala, E:
Son Espases Hosp, Palma De Mallorca, Spain
CIBER Enfermedades Resp, Madrid, Spain
Serrano-Rebollo, JC:
Nuestra Senora del Prado Hosp, Toledo, Spain
Barrot, E:
Virgen del Rocio Hosp, Seville, Spain
Sanchez-Oro-Gomez, R:
Virgen del Rocio Hosp, Seville, Spain
Fernandez-Alvarez, R:
Hosp Cent Asturias, Oviedo, Spain
Rodriguez-Jerez, F:
Hosp Cent Asturias, Oviedo, Spain
Sayas, J:
Doce Octubre Hosp, Madrid, Spain
CIBER Enfermedades Resp, Madrid, Spain
Benavides, P:
Doce Octubre Hosp, Madrid, Spain
CIBER Enfermedades Resp, Madrid, Spain
Catala, R:
Univ Rovira & Virgili, IISPV, St Joan Univ Hosp, Tarragona, Spain
Rivas, FJ:
Txaguritxu Hosp, Vitoria, Spain
CIBER Enfermedades Resp, Madrid, Spain
Egea, CJ:
Txaguritxu Hosp, Vitoria, Spain
CIBER Enfermedades Resp, Madrid, Spain
Anton, A:
St Pau Hosp, Barcelona, Spain
CIBER Enfermedades Resp, Madrid, Spain
Penacoba, P:
St Pau Hosp, Barcelona, Spain
CIBER Enfermedades Resp, Madrid, Spain
Santiago-Recuerda, A:
Hosp La Paz, Madrid, Spain
Gomez-Mendieta, MA:
Hosp La Paz, Madrid, Spain
Mendez, L:
Univ Lucus Augusti Hosp, Lugo, Spain
Cebrian, JJ:
Costa del Sol Hosp, Malaga, Spain
Pina, JA:
Costa del Sol Hosp, Malaga, Spain
Zamora, E:
La Princesa Hosp, Madrid, Spain
Segrelles, G:
La Princesa Hosp, Madrid, Spain
Gold, Green Published
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