| Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. | |
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MedLine Citation:
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PMID: 8045145 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation. DESIGN: Prospective case series. SETTING: Medical intensive care unit in Veterans Administration Medical Center. PATIENTS: Twelve chronic obstructive pulmonary disease patients treated during 14 episodes of hypercapnic respiratory failure. INTERVENTIONS: Nasal mechanical ventilation in addition to conventional therapy to treat hypercapnic respiratory failure. Patients underwent nasal mechanical ventilation for at least 30 mins, or longer if the therapy was tolerated. Responses to therapy and arterial blood gases were monitored. MEASUREMENTS AND MAIN RESULTS: Half of the episodes were successfully treated with nasal mechanical ventilation. There were no differences in age, prior pulmonary function, baseline arterial blood gases, admission arterial blood gases, or respiratory rate between those patients successfully treated and those patients who failed nasal mechanical ventilation. Unsuccessfully treated patients appeared to have a greater severity of illness than successfully treated patients, as indicated by a higher Acute Physiology and Chronic Health Evaluation II score (mean 21 +/- 4 [SD] vs. 15 +/- 4; p = .02). Unsuccessfully treated patients were edentulous, had pneumonia or excess secretions, and had pursed-lip breathing, factors that prevented adequate mouth seal and contributed to greater mouth leaks than in successfully treated patients (the mean volume of the mouth leak was 314 +/- 107 vs. 100 +/- 70 mL; p < .01). Successfully treated patients were able to adapt more rapidly to the nasal mask and ventilator, with greater and more rapid reduction in PaCO2, correction of pH, and reduction in respiratory rate. CONCLUSIONS: Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation. |
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Authors:
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G W Soo Hoo; S Santiago; A J Williams |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 22 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 1994 Aug |
Date Detail:
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Created Date: 1994-09-01 Completed Date: 1994-09-01 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1253-61 Citation Subset: AIM; IM; S |
Affiliation:
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Pulmonary and Critical Care Section, West Los Angeles Veterans Administration Medical Center, CA 90073. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Blood Gas Analysis Female Forced Expiratory Volume Humans Hypercapnia / blood, etiology, mortality, physiopathology, therapy* Lung Diseases, Obstructive / complications* Male Masks / standards* Nose Positive-Pressure Respiration / instrumentation*, methods Prospective Studies Respiration / physiology Respiratory Insufficiency / blood, etiology, mortality, physiopathology, therapy* Severity of Illness Index Survival Rate Tidal Volume Treatment Outcome Vital Capacity |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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