[Non-invasive ventilation in patients with severe hypercapnic encephalopathy in a conventional hospital ward].
OBJECTIVE
To report our experience with non-invasive ventilation (NIV) at two levels of pressure (Bi-PAP) on a general respiratory medicine ward with patients in hypercapnic impaired consciousness and/or coma who had not previously been in an intensive care unit (ICU).


METHODS
This was a prospective study of 13 patients, mean age 81 years (65-96), treated with NIV through a face mask. Ten had chronic obstructive pulmonary disease, with a mean FEV1 in stable condition of 35.2 14.6%. Glasgow scores upon admission were >/= 7. Arterial gases were monitored until suspension of NIV.


RESULTS
After NIV for a mean 19 5 h/day in the first 48 hours and later of 6 1 h/day until a total of 74 9 h, 9 patients (69%) survived. The mean initial pH for these patients was 7.17 0.028 and the mean initial pCO2 was 101 9 mm Hg. In 7 cases (78%), coma was reversed in the first 48 h and a significant improvement in pH was observed in the 12-24 h analysis. Mean pH upon discharge was 7.44 0.013 and mean pCO2 was 54 2.8 mmHg. Four patients died, even though their initial or subsequent arterial gases at 12-24 h were not significantly different from those of the survivors.


CONCLUSIONS
NIV on a general respiratory medicine ward can offer an alternative to oro-tracheal intubation for patients with hypercapnic impaired consciousness and/or coma who do not meet the criteria for admission to the ICU.
Dueñas-Pareja
Y
Y
Servicio de Neumología, Fundación Jiménez Díaz, Madrid, Spain.
López-Martín
S
S
García-García
J
J
Melchor
R
R
Rodríguez-Nieto
M J
MJ
González-Mangado
N
N
Peces-Barba
G
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D003128:Coma / Q000628:therapy*; D003244:Consciousness Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D008297:Male; D008397:Masks; D011175:Positive-Pressure Respiration / Q000295:instrumentation; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012124:Respiratory Care Units; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000628:therapy*
D002245:Carbon Dioxide