Noninvasive versus conventional ventilation to treat hypercapnic encephalopathy in chronic obstructive pulmonary disease.
OBJECTIVE
We recently reported a high success rate using noninvasive positive pressure ventilation (NPPV) to treat COPD exacerbations with hypercapnic encephalopathy. This study compared the hospital outcomes of NPPV vs. conventional mechanical ventilation (CMV) in COPD exacerbations with moderate to severe hypercapnic encephalopathy, defined by a Kelly score of 3 or higher.


METHODS
A 3-year prospective matched case-control study in a respiratory semi-intensive care unit (RSICU) and intensive care unit (ICU).


METHODS
From 103 consecutive patients the study included 20 undergoing NPPV and 20 CMV, matched for age, simplified acute physiology score II, and baseline arterial blood gases.


RESULTS
ABG significantly improved in both groups after 2 h. The rate of complications was lower in the NPPV group than in the CMV group due to fewer cases of nosocomial pneumonia and sepsis. In-hospital mortality, 1-year mortality, and tracheostomy rates were similar in the two groups. Fewer patients remained on ventilation after 30 days in NPPV group. The NPPV group showed a shorter duration of ventilation.


CONCLUSIONS
In COPD exacerbations with moderate to severe hypercapnic encephalopathy, the use of NPPV performed by an experienced team compared to CMV leads to similar short and long-term survivals with a reduced nosocomial infection rate and duration of ventilation.
Scala
Raffaele
R
Unità Operativa di Pneumologia e Unità di Terapia Semi-Intensiva Respiratoria, Arezzo, Italy. raffaele_scala@hotmail.com
Nava
Stefano
S
Conti
Giorgio
G
Antonelli
Massimo
M
Naldi
Mario
M
Archinucci
Ivano
I
Coniglio
Giovanni
G
Hill
Nicholas S
NS
D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000209:etiology / Q000628:therapy*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007558:Italy; D008297:Male; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012128:Respiratory Distress Syndrome