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Analysis of patients with reversible respiratory acidosis after noninvasive mechanical ventilation response in acute hypercapnic respiratory failure

Year 2020, Volume: 1 Issue: 4, 103 - 108, 18.12.2020
https://doi.org/10.47582/jompac.813140

Abstract

Aim: In this study, we aimed to analyze patients with a diagnosis of acute hypercapnic respiratory failure (AHRF) who responded to noninvasive mechanical ventilation (NIMV) in the intensive care unit (ICU) in the first hours but developed severe respiratory acidosis again soon after switching to nasal oxygen.
Material and Method: Between January 2009 and April 2010, data of 139 patients who were followed up in the ICU due to AHRF (pH <7.35 and PaCO2> 45 mmHg) and responded NIMV treatment in the first 1-4 hours, were analyzed retrospectively. Patients were divided into two groups as those with rebound hypercapnia (group 1) and those without rebound hypercapnia (group 2) in their follow-up after the termination of NIMV treatment. Demographic characteristics of the patients, causes of AHRF, duration of NIMV administration, arterial blood gas (ABG) values, APACHE II and SOFA scores, duration of hospitalization (days), need for invasive mechanical ventilation (IMV) and life situations were recorded. Nonparametric Mann-Withney-U test was used for numerical data and Chi-square test for categorical data was used to compare the properties of the groups.
Results: 139 patients were included in the study. There was no difference between the demographic characteristics of the groups and the duration of NIMV use, and the length of stay in the ICU and hospital. Thoracic deformity-muscular diseases (8.6% in group 1, 1.2% in group 2), and obesity hypoventilation syndrome (OHS) (17.2% in group 1, 9.9% in group 2) were more in group 1, parenchymal lung diseases was higher in group 2 (6.9% in group 1, 18.5% in group 2). The situation of using oxygen and NIMV devices at home was similar for both groups. While the pH and PaCO2 values of the groups were similar during ICU admission, there was a significant improvement in group 1 compared to group 2 at the first control (p<0.005, p<0.039 respectively), while a significant deterioration was observed in group 1 after switching to nasal oxygen (p<0.0001, p<0.0001 respectively). However, ABG values at ICU discharge were similar between the two groups. ICU stay days of both groups were found to be similar as 8 (5-12) days in group 1 and 6 (4-10) days in group 2. Necessity of IMV (10.3%; 7.4%, p>0.53 respectively) and mortality rates (6.9%; 9.9% p>0.38 respectively) in group 1 and 2 were found similar.
Conclusion: In our study, we determined that patients with AHRF accompanied by thoracic deformity-muscle diseases and OHS had a rapid clinical response to NIMV administration, but ABG values rapidly deteriorated after switching to nasal oxygen. In this patient group, rapid improvement after NIMV application should not be misleading. Especially, patients who are planned to be hospitalized from the emergency department should be monitored and followed closely after switching to nasal oxygen therapy.

References

  • Bello G, De Pascale G, Antonelli M. Noninvasive ventilation. Clin Chest Med 2016; 37: 711-21.
  • Schnell D, Timsit JF, Darmon M, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med 2014; 40: 582–91.
  • Demoule A, Chevret S, Carlucci A, et al. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med 2016; 42: 82–92.
  • Demoule, A, Girou, E, Richard, JC, et al. Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 2006; 32: 1747.
  • Maheshwari V, Paioli D, Rothaar R, et al. Utilization of noninvasive ventilation in acute care hospitals: a regional survey. Chest 2006; 129: 1226–33.
  • Dikensoy O, İkidağ B, Filiz A, Bayram N. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: A randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract 2002; 56: 85-8.
  • International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in Acute Respiratory Failure. Am J Respir Crit Care Med 2001; 163: 283-91.
  • Diaz GG, Alcaraz AC, Talavera JC, et al. Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure. Chest 2005; 127: 952-60.
  • Evans TW. International Consensus Conferences in Intensive Care Medicine: Noninvasive positive pressure ventilation in acute respiratory failure. organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the societe de Reanimation de Langue Francise, and approved by the ATS Boart of Direction. Intensive Care Med 2001; 27: 166-78.
  • Schönhofer B, Kuhlen R, Neumann P, Westhoff M, Berndt C, Sitter H. Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Deutch Arztebl Int 2008; 105: 424-33.
  • Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 1998; 114: 1636-42.
  • Ozyilmaz E, Ozsancak Ugurlu A, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med. 2014; 14: 19.
  • Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care. Chest 2007; 132: 711-20.
  • Nicolini A, Ferrera L, Santo M, Ferrari-Bravo M, Del Forno M, Sclifò F. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn 2014; 124: 525-31.
  • Kaya A, Çiledağ A, Çaylı İ, Önen ZP, Şen E, Gülbay B. Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure. Tuberk Toraks. 2010; 58: 128-34.
  • Ciledag A, Kaya A, Akdogan BB, et al. Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study. Arch Bronconeumol 2010; 46: 538-42.
  • Vitacca M. Where and how must we perform noninvasive mechanical ventilation? Monaldi Arch Chest Dis 1997; 52: 80-2.
  • Elliott MW, Confalonieri M, Nava S. Where to perform noninvasive ventilation? Eur Respir J 2002; 19: 1159-66.
  • Plant PK, Owen JL, Elliot MW, et al. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: A multicentre randomized controlled trial. Lancet 2000; 355: 1931-5.
  • Allison MG, Winters ME. Noninvasive ventilation for the emergency physician. Emerg Med Clin North Am. 2016; 34: 51-62.
  • Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004; 3: CD004104.
  • Berbenetz N, Wang Y, Brown J, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019; 4: CD005351.
  • Acartürk Tunçay E, Güngör S, Ocaklı B. Noninvasive mechanical ventilation failure and long-term follow-up results of failure in hypercarbic respiratory failure. Duzce Medical Journal 2019; 21: 54-60.
  • Crummy F, Buchan C, Miller B, et al. The use of noninvasive mechanical ventilation in COPD with severe hypercapnic acidosis. Respiratory Medicine 2007; 101: 53-61.
  • Bacakoğlu F, Taşbakan MS, Kaçmaz Başoğlu Ö, et al. The factors affecting noninvasive mechanical ventilation failure in COPD exacerbations. Turk J Med Sci. 2012; 42: 103-12.
  • Honrubia T, Garcia Lopez FJ, Franco N, et al. Noninvasive vs conventional mechanical ventilation in acute respiratory failure: A multicenter, randomized controlled trial. Chest 2005; 128: 3916-24.
  • Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J. 2005; 25: 348-55.
  • Çiledağ A, Kaya A, Erçen Diken Ö, Önen ZP, Şen E, Demir N. The risk factors for late failure of noninvasive mechanical ventilation in acute hypercapnic respiratory failure. Tuberk Toraks 2014; 62: 177-82.
  • Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multicenter study. Intensive Care Med 2001; 27: 1718–28.
  • Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest 2003; 124: 699-713.
  • Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 2003; 168: 1432-7.
  • Crane SD, Elliott MW, Gilligan P, et al. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department in patients with acute cardiogenic pulmonary oedema. Emerg Med J 2004; 21: 155–61.
  • Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142–51.
  • Güsel G, Aydoğdu M, Gülbaş G, Özkaya S, Taşyürek S, Yıldırım F. The influence of severe obesity on non-invasive ventilation (NIMV) strategies and responses in patients with acute hypercapnic respiratory failure attacks in the ICU. Minerva Anestesiol 2011; 77: 17-25.

Akut hiperkapnik solunum yetmezliğinde noninvaziv mekanik ventilasyon yanıtı sonrasında geri dönüşümlü respiratuvar asidozlu hastaların analizi

Year 2020, Volume: 1 Issue: 4, 103 - 108, 18.12.2020
https://doi.org/10.47582/jompac.813140

Abstract

Amaç: Bu çalışmada akut hiperkapnik solunum yetmezliği (AHSY) tanısı ile yoğun bakım ünites (YBÜ)’inde noninvaziv mekanik ventilasyon (NIMV) uygulamasına ilk saatlerde iyi yanıt alınan, ancak nazal oksijene geçildikten kısa süre sonra tekrar ciddi solunumsal asidoz gelişen hastaların analizini yapmayı planladık.
Gereç ve Yöntem: Ocak 2009-Nisan 2010 tarihleri arasında, AHSY (pH<7,35 ve PaCO2 >45 mmHg) nedeniyle YBÜ’de takip edilen ve uygulanan ilk 1-4 saatlik NIMV tedavisine yanıt veren 139 hastanın verisi retrospektif olarak incelendi. Hastalar, NIMV tedavisi sonlandırıldıktan sonraki takiplerinde rebound hiperkapni gelişen (grup 1) ve gelişmeyen (grup 2) olmak üzere iki gruba ayrıldı. Hastaların demografik özellikleri, AHSY nedenleri, NIMV uygulama süreleri, arteriyel kan gazı (AKG) değerleri, APACHE-II ve SOFA skorları, hastanede yatış süresi (gün), invaziv mekanik ventilatör (İMV) ihtiyacı ve yaşam durumları kaydedildi. Grupların özelliklerini karşılaştırmada numerik veriler için nonparametrik Mann-Withney-U testi ve kategorik veriler için Ki-kare testi kullanıldı.
Bulgular: Çalışmaya 139 hasta dâhil edildi. Grupların demografik özellikleri ve NIMV süreleri, YBÜ ve hastane kalış süreleri arasında fark bulunmadı. Grup 1’de toraks deformitesi-kas hastalıkları (grup 1’de %8,6; grup 2’de %1,2) ve obezite hipoventilasyon sendromu (OHS) (grup 1’de %17,2; grup 2’de %9,9) daha fazla iken; grup 2’de parankimal akciğer hastalıkları fazla (grup 1’de %6,9; grup 2’de %18,5) idi. Her iki grup için evde oksijen ve NIMV cihazı kullanıyor olma durumları benzerdi. Grupların pH ve PaCO2 değerleri YBÜ’ye kabul esnasında benzerken, ilk kontrolde grup 1’de grup 2’ye göre belirgin düzelme varken (sırasıyla p<0,005 ve p<0,039) nazal oksijene geçilmesiyle grup 1’de belirgin kötüleşme görüldü (sırasıyla p<0,0001 ve p<0,0001); ancak YBÜ çıkış AKG değerleri iki grup arasında benzerdi. Her iki grubun YBÜ kalış günleri grup 1’de 8 (5-12) gün; grup 2’de 6 (4-10) gün olarak benzer bulundu. Grup 1 ve 2’de YBÜ’de IMV’ye geçiş (sırasıyla %10,3; %7,4, p>0,53) ve mortalite oranları (sırasıyla %6,9; %9,9, p>0,38) benzer saptandı.
Sonuç: Çalışmamızda toraks deformitesi-kas hastalıkları ve OHS’nin eşlik ettiği AHSY olan hastalarda NIMV uygulanmasına hızlı klinik yanıt alındığını ancak nazal oksijene geçildikten kısa süre sonra AKG değerlerinin kötüleştiğini saptadık. Bu hasta grubunda NIMV uygulaması sonrası hızlı düzelme yanıltıcı olmamalıdır. Özellikle acil servisten yatışı planlanan bu hastalar nazal oksijen tedavisine geçilse bile mutlaka monitörize edilerek yakın takibe alınmalıdır.

References

  • Bello G, De Pascale G, Antonelli M. Noninvasive ventilation. Clin Chest Med 2016; 37: 711-21.
  • Schnell D, Timsit JF, Darmon M, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med 2014; 40: 582–91.
  • Demoule A, Chevret S, Carlucci A, et al. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med 2016; 42: 82–92.
  • Demoule, A, Girou, E, Richard, JC, et al. Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 2006; 32: 1747.
  • Maheshwari V, Paioli D, Rothaar R, et al. Utilization of noninvasive ventilation in acute care hospitals: a regional survey. Chest 2006; 129: 1226–33.
  • Dikensoy O, İkidağ B, Filiz A, Bayram N. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: A randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract 2002; 56: 85-8.
  • International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in Acute Respiratory Failure. Am J Respir Crit Care Med 2001; 163: 283-91.
  • Diaz GG, Alcaraz AC, Talavera JC, et al. Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure. Chest 2005; 127: 952-60.
  • Evans TW. International Consensus Conferences in Intensive Care Medicine: Noninvasive positive pressure ventilation in acute respiratory failure. organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the societe de Reanimation de Langue Francise, and approved by the ATS Boart of Direction. Intensive Care Med 2001; 27: 166-78.
  • Schönhofer B, Kuhlen R, Neumann P, Westhoff M, Berndt C, Sitter H. Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Deutch Arztebl Int 2008; 105: 424-33.
  • Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 1998; 114: 1636-42.
  • Ozyilmaz E, Ozsancak Ugurlu A, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med. 2014; 14: 19.
  • Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care. Chest 2007; 132: 711-20.
  • Nicolini A, Ferrera L, Santo M, Ferrari-Bravo M, Del Forno M, Sclifò F. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn 2014; 124: 525-31.
  • Kaya A, Çiledağ A, Çaylı İ, Önen ZP, Şen E, Gülbay B. Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure. Tuberk Toraks. 2010; 58: 128-34.
  • Ciledag A, Kaya A, Akdogan BB, et al. Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study. Arch Bronconeumol 2010; 46: 538-42.
  • Vitacca M. Where and how must we perform noninvasive mechanical ventilation? Monaldi Arch Chest Dis 1997; 52: 80-2.
  • Elliott MW, Confalonieri M, Nava S. Where to perform noninvasive ventilation? Eur Respir J 2002; 19: 1159-66.
  • Plant PK, Owen JL, Elliot MW, et al. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: A multicentre randomized controlled trial. Lancet 2000; 355: 1931-5.
  • Allison MG, Winters ME. Noninvasive ventilation for the emergency physician. Emerg Med Clin North Am. 2016; 34: 51-62.
  • Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004; 3: CD004104.
  • Berbenetz N, Wang Y, Brown J, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019; 4: CD005351.
  • Acartürk Tunçay E, Güngör S, Ocaklı B. Noninvasive mechanical ventilation failure and long-term follow-up results of failure in hypercarbic respiratory failure. Duzce Medical Journal 2019; 21: 54-60.
  • Crummy F, Buchan C, Miller B, et al. The use of noninvasive mechanical ventilation in COPD with severe hypercapnic acidosis. Respiratory Medicine 2007; 101: 53-61.
  • Bacakoğlu F, Taşbakan MS, Kaçmaz Başoğlu Ö, et al. The factors affecting noninvasive mechanical ventilation failure in COPD exacerbations. Turk J Med Sci. 2012; 42: 103-12.
  • Honrubia T, Garcia Lopez FJ, Franco N, et al. Noninvasive vs conventional mechanical ventilation in acute respiratory failure: A multicenter, randomized controlled trial. Chest 2005; 128: 3916-24.
  • Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J. 2005; 25: 348-55.
  • Çiledağ A, Kaya A, Erçen Diken Ö, Önen ZP, Şen E, Demir N. The risk factors for late failure of noninvasive mechanical ventilation in acute hypercapnic respiratory failure. Tuberk Toraks 2014; 62: 177-82.
  • Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multicenter study. Intensive Care Med 2001; 27: 1718–28.
  • Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest 2003; 124: 699-713.
  • Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 2003; 168: 1432-7.
  • Crane SD, Elliott MW, Gilligan P, et al. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department in patients with acute cardiogenic pulmonary oedema. Emerg Med J 2004; 21: 155–61.
  • Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142–51.
  • Güsel G, Aydoğdu M, Gülbaş G, Özkaya S, Taşyürek S, Yıldırım F. The influence of severe obesity on non-invasive ventilation (NIMV) strategies and responses in patients with acute hypercapnic respiratory failure attacks in the ICU. Minerva Anestesiol 2011; 77: 17-25.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Hüseyin Arpağ 0000-0002-0942-6011

Zuhal Karakurt 0000-0003-1635-0016

Tülin Kuyucu This is me 0000-0002-8402-2877

Abdullah Kansu 0000-0001-8902-5498

Nurhan Atilla 0000-0003-4127-4924

Publication Date December 18, 2020
Published in Issue Year 2020 Volume: 1 Issue: 4

Cite

AMA Arpağ H, Karakurt Z, Kuyucu T, Kansu A, Atilla N. Akut hiperkapnik solunum yetmezliğinde noninvaziv mekanik ventilasyon yanıtı sonrasında geri dönüşümlü respiratuvar asidozlu hastaların analizi. J Med Palliat Care / JOMPAC / jompac. December 2020;1(4):103-108. doi:10.47582/jompac.813140

TR DİZİN ULAKBİM and International Indexes (1d)

Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]



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