[Sequential non-invasive following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure].
OBJECTIVE
To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation(MV) in COPD with exacerbated hypercapnic respiratory failure.


METHODS
22 intubated COPD cases with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis. We call the time as "Pulmonary Infection Control Window", PIC window) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were used as control group.


RESULTS
The groups had similar clinical characteristics and gas exchange, initially and at the time of PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, P < 0.01; the total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, P < 0.05; the incidence of VAP were 0/11 vs 6/11, P < 0.01; the duration of ICU stay was (13 +/- 7) vs (26 +/- 14) days, P < 0.05, respectively.


CONCLUSIONS
In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window may significantly decrease the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.
Wang
C
C
Beijing Red Cross Chaoyang Hospital-Beijing Institute of Respiratory Medicine, Capital University of Medical Sciences, Beijing 100020, China.
Shang
M
M
Huang
K
K
D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome