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- Title
Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.
- Authors
Fiorino, S.; Bacchi‐Reggiani, L.; Detotto, E.; Battilana, M.; Borghi, E.; Denitto, C.; Dickmans, C.; Facchini, B.; Moretti, R.; Parini, S.; Testi, M.; Zamboni, A.; Cuppini, A.; Pisani, L.; Nava, S.
- Abstract
Aim To date non-invasive ( NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease ( COPD) patients with acute respiratory failure ( ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases ( ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis ( RA) admitted to an experienced rural medical ward. Methods This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria ( pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A ( pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge. Results Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen per cent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate ( MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome. Conclusion In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.
- Subjects
ITALY; OBSTRUCTIVE lung disease treatment; ANALYSIS of variance; ARTIFICIAL respiration; CHI-squared test; CLINICAL trials; LONGITUDINAL method; RESPIRATORY acidosis; MULTIVARIATE analysis; RESPIRATORY insufficiency; STATISTICS; COMORBIDITY; LOGISTIC regression analysis; PILOT projects; DATA analysis; TREATMENT effectiveness; REPEATED measures design; DATA analysis software; DESCRIPTIVE statistics
- Publication
Internal Medicine Journal, 2015, Vol 45, Issue 5, p527
- ISSN
1444-0903
- Publication type
Article
- DOI
10.1111/imj.12726