Noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and severe hypercapnic neurological deterioration in the emergency room.
OBJECTIVE
The objective of this study was to assess the effectiveness of noninvasive motion ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD), having infectious exacerbation and severe hypercapnic neurological dysfunction in the emergency room.


METHODS
This is a prospective interventional study.


METHODS
The study setting was the emergency room at the Military Hospital in Guayaquil, Ecuador.


METHODS
A total of 24 patients were studied. Twelve patients had acute exacerbation of their chronic obstructive pulmonary disease: they presented at the emergency room with severe neurological dysfunction, with a Glasgow Coma Scale (GCS) score of less than 8 and a pH of less than 7.25. These patients were compared with 12 controls who were being treated with invasive mechanical ventilation (IMV), who were then matched according to their GCS scores, pH status, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and age.


METHODS
We evaluated the effectiveness and safety of applying a ventilatory strategy based on a biphasic positive airway pressure protocol in the emergency room.


RESULTS
The pH, PCO2, and GCS scores, measured during the first 3 h, were predictors of success for the application of NIMV treatment (P<0.05). Mortality was 33.3 and 16.7% for the IMV and the NIMV groups, respectively (P=0.01). Days of IMV were 5.60+/-1.2 versus 3.6+/-1.1 for NIMV (P=0.006). Days of hospitalization were 11.1+/-4.7 for the IMV group and 6.5+/-1.9 for the NIMV group (P=0.001). The cumulative survival rates at 6 months were 71.4 and 80% for the IMV and NIMV groups, respectively (P=0.80).


CONCLUSIONS
We consider that severe neurological dysfunction and pH of less than 7.25 do not constitute absolute contraindications to the use of NIMV. This kind of management can be implemented in the emergency room with favorable results.
Briones Claudett
Killen Harold
KH
Pneumology Department of Military Hospital, Guayaquil, Ecuador. kyllenb@interactive.net.ec
Briones Claudett
Mónica H
MH
Chung Sang Wong
Miguel A
MA
Andrade
Michelle Grunauer
MG
Cruz Pico
Christian X
CX
Cruz
Cristhian X
CX
Esquinas
Antonio
A
Diaz
Gumersindo Gonzalez
GG
D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care / Q000379:methods; D004636:Emergency Service, Hospital; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000628:therapy*; D007385:Intermittent Positive-Pressure Ventilation; D007902:Length of Stay; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012129:Respiratory Function Tests; D016019:Survival Analysis