Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units

Background: 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 f...

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Autores: Masa, JF, Utrabo, I, de Terreros, JG, Aburto, M, Esteban, C, Prats, E, Nunez, B, Ortega-Gonzalez, A, Jara-Palomares, L, Martin-Vicente, MJ, Farrero, E, Binimelis, A, Sala, E, Serrano-Rebollo, JC, Barrot, E, Sanchez-Oro-Gomez, R, Fernandez-Alvarez, R, Rodriguez-Jerez, F, Sayas, J, Benavides, P, Catala, R, Rivas, FJ, Egea, CJ, Anton, A, Penacoba, P, Santiago-Recuerda, A, Gomez-Mendieta, MA, Mendez, L, Cebrian, JJ, Pina, JA, Zamora, E, Segrelles, G
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p7175
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7175
Access Level:acceso abierto
Palabra clave:Noninvasive ventilation
Respiratory intermediate care unit
Acute hypercapnic respiratory failure
COPD
Acute pulmonary edema
Obesity hypoventilation syndrome
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spelling Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care unitsMasa, JFUtrabo, Ide Terreros, JGAburto, MEsteban, CPrats, ENunez, BOrtega-Gonzalez, AJara-Palomares, LMartin-Vicente, MJFarrero, EBinimelis, ASala, ESerrano-Rebollo, JCBarrot, ESanchez-Oro-Gomez, RFernandez-Alvarez, RRodriguez-Jerez, FSayas, JBenavides, PCatala, RRivas, FJEgea, CJAnton, APenacoba, PSantiago-Recuerda, AGomez-Mendieta, MAMendez, LCebrian, JJPina, JAZamora, ESegrelles, GNoninvasive ventilationRespiratory intermediate care unitAcute hypercapnic respiratory failureCOPDAcute pulmonary edemaObesity hypoventilation syndromeBackground: 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. Methods: 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. (Continued on next page) Results: 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 PaCO2 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. Conclusions: 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.BMC2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7175BMC Pulmonary MedicineISSN: 14712466reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p71752026-06-14T12:41:47Z
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 Precision medicine in intermediate care units
spellingShingle Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
Masa, JF
Noninvasive ventilation
Respiratory intermediate care unit
Acute hypercapnic respiratory failure
COPD
Acute pulmonary edema
Obesity hypoventilation syndrome
title_short Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
title_full Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
title_fullStr Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
title_full_unstemmed Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
title_sort Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units
dc.creator.none.fl_str_mv Masa, JF
Utrabo, I
de Terreros, JG
Aburto, M
Esteban, C
Prats, E
Nunez, B
Ortega-Gonzalez, A
Jara-Palomares, L
Martin-Vicente, MJ
Farrero, E
Binimelis, A
Sala, E
Serrano-Rebollo, JC
Barrot, E
Sanchez-Oro-Gomez, R
Fernandez-Alvarez, R
Rodriguez-Jerez, F
Sayas, J
Benavides, P
Catala, R
Rivas, FJ
Egea, CJ
Anton, A
Penacoba, P
Santiago-Recuerda, A
Gomez-Mendieta, MA
Mendez, L
Cebrian, JJ
Pina, JA
Zamora, E
Segrelles, G
author Masa, JF
author_facet Masa, JF
Utrabo, I
de Terreros, JG
Aburto, M
Esteban, C
Prats, E
Nunez, B
Ortega-Gonzalez, A
Jara-Palomares, L
Martin-Vicente, MJ
Farrero, E
Binimelis, A
Sala, E
Serrano-Rebollo, JC
Barrot, E
Sanchez-Oro-Gomez, R
Fernandez-Alvarez, R
Rodriguez-Jerez, F
Sayas, J
Benavides, P
Catala, R
Rivas, FJ
Egea, CJ
Anton, A
Penacoba, P
Santiago-Recuerda, A
Gomez-Mendieta, MA
Mendez, L
Cebrian, JJ
Pina, JA
Zamora, E
Segrelles, G
author_role author
author2 Utrabo, I
de Terreros, JG
Aburto, M
Esteban, C
Prats, E
Nunez, B
Ortega-Gonzalez, A
Jara-Palomares, L
Martin-Vicente, MJ
Farrero, E
Binimelis, A
Sala, E
Serrano-Rebollo, JC
Barrot, E
Sanchez-Oro-Gomez, R
Fernandez-Alvarez, R
Rodriguez-Jerez, F
Sayas, J
Benavides, P
Catala, R
Rivas, FJ
Egea, CJ
Anton, A
Penacoba, P
Santiago-Recuerda, A
Gomez-Mendieta, MA
Mendez, L
Cebrian, JJ
Pina, JA
Zamora, E
Segrelles, G
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.subject.none.fl_str_mv Noninvasive ventilation
Respiratory intermediate care unit
Acute hypercapnic respiratory failure
COPD
Acute pulmonary edema
Obesity hypoventilation syndrome
topic Noninvasive ventilation
Respiratory intermediate care unit
Acute hypercapnic respiratory failure
COPD
Acute pulmonary edema
Obesity hypoventilation syndrome
description Background: 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. Methods: 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. (Continued on next page) Results: 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 PaCO2 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. Conclusions: 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 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7175
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7175
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv BMC Pulmonary Medicine
ISSN: 14712466
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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