Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units
Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in pa...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:289645 |
| Acceso en línea: | https://ddd.uab.cat/record/289645 https://dx.doi.org/urn:doi:10.1186/s12890-016-0262-9 |
| Access Level: | acceso abierto |
| Palabra clave: | Acute hypercapnic respiratory failure Acute pulmonary edema COPD Noninvasive ventilation Obesity hypoventilation syndrome Respiratory intermediate care unit |
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ES_15b30896dafd760e01b15a7537de2476 |
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oai:ddd.uab.cat:289645 |
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ES |
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España |
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| dc.title.none.fl_str_mv |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units |
| title |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| spellingShingle |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Masa, Juan F. Acute hypercapnic respiratory failure Acute pulmonary edema COPD Noninvasive ventilation Obesity hypoventilation syndrome Respiratory intermediate care unit |
| title_short |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| title_full |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| title_fullStr |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| title_full_unstemmed |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| title_sort |
Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units |
| dc.creator.none.fl_str_mv |
Masa, Juan F. Utrabo, Isabel Gomez de Terreros, Javier Aburto, Myriam|||0000-0001-8644-1015 Esteban, Cristóbal Prats, Enric Núñez, Belén Ortega-González, Ángel Jara-Palomares, Luis|||0000-0002-4125-3376 Martin-Vicente, M.Jesus Farrero, Eva|||0000-0001-5269-2457 Binimelis, Alicia Sala, Ernest Serrano-Rebollo, José C. Barrot, Emilia Sánchez-Oro-Gomez, Raquel Fernández-Álvarez, Ramón Rodríguez-Jerez, Francisco Sayas, Javier|||0000-0003-2399-4370 Benavides, Pedro Català, Raquel Rivas, Francisco J. Egea, Carlos J. Antón, Antonio|||0000-0002-4189-4472 Peñacoba, Patricia|||0000-0001-8943-7425 Santiago-Recuerda, Ana Gómez-Mendieta, M.A. Méndez, Lidia Cebrian, José J. Piña, Juan A. Zamora, Enrique Segrelles, Gonzalo |
| author |
Masa, Juan F. |
| author_facet |
Masa, Juan F. Utrabo, Isabel Gomez de Terreros, Javier Aburto, Myriam|||0000-0001-8644-1015 Esteban, Cristóbal Prats, Enric Núñez, Belén Ortega-González, Ángel Jara-Palomares, Luis|||0000-0002-4125-3376 Martin-Vicente, M.Jesus Farrero, Eva|||0000-0001-5269-2457 Binimelis, Alicia Sala, Ernest Serrano-Rebollo, José C. Barrot, Emilia Sánchez-Oro-Gomez, Raquel Fernández-Álvarez, Ramón Rodríguez-Jerez, Francisco Sayas, Javier|||0000-0003-2399-4370 Benavides, Pedro Català, Raquel Rivas, Francisco J. Egea, Carlos J. Antón, Antonio|||0000-0002-4189-4472 Peñacoba, Patricia|||0000-0001-8943-7425 Santiago-Recuerda, Ana Gómez-Mendieta, M.A. Méndez, Lidia Cebrian, José J. Piña, Juan A. Zamora, Enrique Segrelles, Gonzalo |
| author_role |
author |
| author2 |
Utrabo, Isabel Gomez de Terreros, Javier Aburto, Myriam|||0000-0001-8644-1015 Esteban, Cristóbal Prats, Enric Núñez, Belén Ortega-González, Ángel Jara-Palomares, Luis|||0000-0002-4125-3376 Martin-Vicente, M.Jesus Farrero, Eva|||0000-0001-5269-2457 Binimelis, Alicia Sala, Ernest Serrano-Rebollo, José C. Barrot, Emilia Sánchez-Oro-Gomez, Raquel Fernández-Álvarez, Ramón Rodríguez-Jerez, Francisco Sayas, Javier|||0000-0003-2399-4370 Benavides, Pedro Català, Raquel Rivas, Francisco J. Egea, Carlos J. Antón, Antonio|||0000-0002-4189-4472 Peñacoba, Patricia|||0000-0001-8943-7425 Santiago-Recuerda, Ana Gómez-Mendieta, M.A. Méndez, Lidia Cebrian, José J. Piña, Juan A. Zamora, Enrique Segrelles, Gonzalo |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Universitat Autònoma de Barcelona |
| dc.subject.none.fl_str_mv |
Acute hypercapnic respiratory failure Acute pulmonary edema COPD Noninvasive ventilation Obesity hypoventilation syndrome Respiratory intermediate care unit |
| topic |
Acute hypercapnic respiratory failure Acute pulmonary edema COPD Noninvasive ventilation Obesity hypoventilation syndrome Respiratory intermediate care unit |
| description |
Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. ACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria. |
| publishDate |
2016 |
| dc.date.none.fl_str_mv |
2 2016-01-01 2016 2016-01-01 |
| dc.type.none.fl_str_mv |
Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://ddd.uab.cat/record/289645 https://dx.doi.org/urn:doi:10.1186/s12890-016-0262-9 |
| url |
https://ddd.uab.cat/record/289645 https://dx.doi.org/urn:doi:10.1186/s12890-016-0262-9 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf |
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reponame:Dipòsit Digital de Documents de la UAB instname:Universitat Autònoma de Barcelona |
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Universitat Autònoma de Barcelona |
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Dipòsit Digital de Documents de la UAB |
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Dipòsit Digital de Documents de la UAB |
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Noninvasive ventilation for severely acidotic patients in respiratory intermediate care unitsPrecision medicine in intermediate care unitsMasa, Juan F.Utrabo, IsabelGomez de Terreros, JavierAburto, Myriam|||0000-0001-8644-1015Esteban, CristóbalPrats, EnricNúñez, BelénOrtega-González, ÁngelJara-Palomares, Luis|||0000-0002-4125-3376Martin-Vicente, M.JesusFarrero, Eva|||0000-0001-5269-2457Binimelis, AliciaSala, ErnestSerrano-Rebollo, José C.Barrot, EmiliaSánchez-Oro-Gomez, RaquelFernández-Álvarez, RamónRodríguez-Jerez, FranciscoSayas, Javier|||0000-0003-2399-4370Benavides, PedroCatalà, RaquelRivas, Francisco J.Egea, Carlos J.Antón, Antonio|||0000-0002-4189-4472Peñacoba, Patricia|||0000-0001-8943-7425Santiago-Recuerda, AnaGómez-Mendieta, M.A.Méndez, LidiaCebrian, José J.Piña, Juan A.Zamora, EnriqueSegrelles, GonzaloAcute hypercapnic respiratory failureAcute pulmonary edemaCOPDNoninvasive ventilationObesity hypoventilation syndromeRespiratory intermediate care unitSevere acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. ACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.Universitat Autònoma de Barcelona 22016-01-0120162016-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/289645https://dx.doi.org/urn:doi:10.1186/s12890-016-0262-9reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2896452026-06-06T12:50:31Z |
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15.301603 |