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. Issue 5 (May 2015)

• Record Type: Journal Article
• 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.
• Is Part Of: Internal medicine journal. Volume 45:Issue 5(2015)
• Page Start: 527
• Page End: 537
• Publication Date: 2015-05
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12726
• Languages: English
• ISSNs: 1444-0903

Abstract

&lt;abstract abstract-type=&quot;main&quot;&gt; &lt;title&gt;Abstract&lt;/title&gt; &lt;sec id=&quot;imj12726-sec-0001&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Aim&lt;/title&gt; &lt;p&gt;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 &amp;lt; 7.30 outside a &#39;protected environment&#39;. 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.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;imj12726-sec-0002&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio&#39;s District Hospital. Two hundred and seventy‐two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH &amp;lt; 7.35, PaCO&lt;sub&gt;2&lt;/sub&gt; &amp;gt; 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH &amp;lt; 7.26), group B (7.26 ≤ pH &amp;lt; 7.30) and group C (7.30 ≤ pH &amp;lt; 7.35). ABG were assessed at admission, at 2–6 h, 24 h, 48 h and at discharge.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;imj12726-sec-0005&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;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.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;imj12726-sec-0006&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;In a non‐&#39;highly protected&#39; 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.&lt;/p&gt; &lt;/sec&gt; &lt;/abstract&gt;