Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure.
BACKGROUND
Hypercapnic coma secondary to acute respiratory failure (ARF) is considered to be a contraindication to the use of treatment with noninvasive positive-pressure ventilation (NPPV). However, intubation exposes these patients to the risk of complications such as nosocomial pneumonia, sepsis, and even death.


METHODS
We performed a prospective, open, noncontrolled study to assess the outcomes of NPPV therapy in patients with a Glasgow coma scale (GCS) score of </= 8 points due to ARF. The primary goal of the study was to determine the success of NPPV therapy (defined as a response to therapy allowing the patient to avoid endotracheal intubation, and to survive a stay in the ICU and at least 24 h on a medical ward) in patients with hypercapnic coma, compared to those who started NPPV therapy while awake. The secondary goal of the study was to identify the variables that can predict a failure of NPPV therapy in these patients.


RESULTS
A total of 76 coma patients (80%) responded to NPPV therapy, and 605 patients with GCS scores > 8 responded to therapy (70%; p = 0.04). A total of 25 coma patients died in the hospital (26.3%), and 287 noncoma patients died in the hospital (33.2%; p = 0.17). The variables related to the success of NPPV therapy were GCS score 1 h posttherapy (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.53 to 3.53) and higher levels of multiorgan dysfunction, as measured by the maximum sequential organ failure assessment index score reached during NPPV therapy (OR, 0.72; 95% CI, 0.55 to 0.92).


CONCLUSIONS
We concluded that selected patients with hypercapnic coma secondary to ARF can be treated as successfully with NPPV as awake patients with ARF.
Díaz
Gumersindo Gónzalez
GG
Intensive Care Unit, Hospital Morales Meseguer, C/Marqués de los Velez s/n, 30008 Murcia, Spain. gumersindoj.gonzalez@carm.es
Alcaraz
Andres Carrillo
AC
Talavera
Juan Carlos Pardo
JC
Pérez
Pedro Jara
PJ
Rodriguez
Antonio Esquinas
AE
Cordoba
Francisco García
FG
Hill
Nicholas S
NS
D018806:APACHE; D000208:Acute Disease; D000368:Aged; D003128:Coma / Q000150:complications* / Q000401:mortality; D000075202:Contraindications; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000150:complications*; D008297:Male; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome