Efficacy of Noninvasive Mechanical Ventilation (Niv) in the General Ward in Patients with Chronic Obstructive Pulmonary (Copd) Disease Admitted for Hypercapnic Acute Respiratory Failure (Arf) and Ph<7.35: A Feasibility Pilot Study.
Intern Med J. 2015 Feb 13;
Authors: Fiorino S, Bacchi-Reggiani L, Detotto E, Battilana M, Borghi E, Denitto C, Dickmans C, Facchini B, Moretti R, Parini S, Testi M, Zamboni A, Cuppini A, Pisani L, Nava S
OBJECTIVE: to date NIV use is not recommended in COPD patients with ARF and pH<7.30 outside a "protected environment". We assessed NIV efficacy and feasibility in improving arterial blood gases (ABGs) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward.
DESIGN: Prospective pilot cohort study.
SETTING: Budrio's Hospital Medicine Ward PATIENTS: 272 patients with ARF were admitted to our Departement, 112, meeting predefined inclusion criteria (pH<7.35, PaC02 >45mmHg), were divided according to the severity of acidosis into: Group A (GA) (pH<7.26), Group B (GB) (7.26≤pH<7.30) and Group C (GC) (7.30≤pH<7.35). ABGs were assessed at admission, at 2-6 hours, 24h, 48h and at discharge.
RESULTS: GA included 55 patients (24Men, mean age: 80.8±8.3 yrs), GB 31 (12Men, mean age: 80.3±9.4 yrs), and GC 26 (15Men, mean age: 78.6±9.9 yrs). ABGs improved within the first hours in 92/112 (82%), who were all successfully discharged. 20/112 (18%) patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for GA, B and C respectively) and between patients with or without pneumonia: 8/29 (27%) vs 12/83 (14%). On multivariable analysis, only age and GCS had an impact on the clinical outcome.
CONCLUSION: In a non 'highly protected" environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.
PMID: 25684643 [PubMed - as supplied by publisher]