Abstract
Management with non-invasive mechanical ventilation (NIMV) in exacerbations of chronic obstructive
pulmonary disease (COPD) reduces the need for intubation and the associated complications. It is
therefore indicated in clinical settings of acute respiratory failure. The gasometric variables described
at sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level).
The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy)
and to describe the variables at admission associated with failure in patients with exacerbation
of COPD and respiratory failure that require management in the intensive care unit (ICU).
METHODS: a retrospective cohort was analyzed; clinical characteristics, severity scores, and gasometric
values were registered. The differences between the success and failure groups were evaluated.
A logistic regression analysis was applied to explore factors associated with outcome.
RESULTS: 158 patients were included; 54,5% were women; the mean age was 74,3±8,8 years.
Characteristics at admission: APACHE 17,1±4,1, PaCO2
52,7±14,9 mm Hg, PaO2
/FIO2
166,6±61,1,
pH 7,32±0,09, FC 104,4±23,1. Management with BiPAP: 93%, CPAP: 7%. NIMV failed in 24,1%
(orotracheal intubation: 15,8%, tracheostomy: 6,3%, and mortality: 12%). On multivariate analysis,
the variables associated with failure were: APACHE ≥17 (OR: 2,34 [1,04-5,3]) and PaCO2
≥55 (OR:
2,47 [1,08-5,79]). There was no association with sex or PaO2
/FIO2
.
CONCLUSIONS: the percentage of failure with NIMV (24,1%) was less than that reported in the international
literature. The risk factors found (high APACHE and PaCO2
) are confirmed as predictors of
failure in NIMV, and are applicable to Bogotá or similar altitudes. High altitudes do not appear to have
influence on the outcomes of patients with COPD exacerbations that require management in an ICU.
pulmonary disease (COPD) reduces the need for intubation and the associated complications. It is
therefore indicated in clinical settings of acute respiratory failure. The gasometric variables described
at sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level).
The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy)
and to describe the variables at admission associated with failure in patients with exacerbation
of COPD and respiratory failure that require management in the intensive care unit (ICU).
METHODS: a retrospective cohort was analyzed; clinical characteristics, severity scores, and gasometric
values were registered. The differences between the success and failure groups were evaluated.
A logistic regression analysis was applied to explore factors associated with outcome.
RESULTS: 158 patients were included; 54,5% were women; the mean age was 74,3±8,8 years.
Characteristics at admission: APACHE 17,1±4,1, PaCO2
52,7±14,9 mm Hg, PaO2
/FIO2
166,6±61,1,
pH 7,32±0,09, FC 104,4±23,1. Management with BiPAP: 93%, CPAP: 7%. NIMV failed in 24,1%
(orotracheal intubation: 15,8%, tracheostomy: 6,3%, and mortality: 12%). On multivariate analysis,
the variables associated with failure were: APACHE ≥17 (OR: 2,34 [1,04-5,3]) and PaCO2
≥55 (OR:
2,47 [1,08-5,79]). There was no association with sex or PaO2
/FIO2
.
CONCLUSIONS: the percentage of failure with NIMV (24,1%) was less than that reported in the international
literature. The risk factors found (high APACHE and PaCO2
) are confirmed as predictors of
failure in NIMV, and are applicable to Bogotá or similar altitudes. High altitudes do not appear to have
influence on the outcomes of patients with COPD exacerbations that require management in an ICU.
| Translated title of the contribution | Prediction of failure in non-invasive mechanical ventilation for respiratory failure in chronic obstructive pulmonary disease at high altitudes |
|---|---|
| Original language | Spanish |
| Pages (from-to) | 12 - 17 |
| Number of pages | 5 |
| Journal | Acta Colombiana de Cuidado Intensivo |
| Volume | 13 |
| Issue number | 1 |
| State | Published - 2013 |