Utility of respiratory ward-based NIV in acidotic hypercapnic respiratory failure

作者：Dave Chirag; Turner Alice; Thomas Ajit; Beauchamp Ben; Chakraborty Biman; Ali Asad; Mukherjee Rahul^*; Banerjee Dev

来源：Respirology, 2014, 19(8): 1241-1247.

DOI：10.1111/resp.12366

• chronic obstructive pulmonary disease
• exacerbation
• non-invasive ventilation
• rational use of resources
• respiratory failure

Background and objectiveWe sought to elicit predictors of in-hospital mortality for first and subsequent admissions with acidotic hypercapnic respiratory failure (AHRF) in a cohort of chronic obstructive pulmonary disease patients who have undergone ward-based non-invasive ventilation (NIV), and identify features associated with long-term survival. %26lt;br%26gt;MethodsAnalysis of prospectively collected data at a single centre on patients undergoing NIV for AHRF between 2004 and 2009. Predictors of in-hospital mortality and intubation were sought by logistic regression and predictors of long-term survival by Cox regression. %26lt;br%26gt;ResultsInitial pH exhibited a threshold effect for in-hospital mortality at pH7.15. This relationship remained in patients undergoing their first episode of AHRF. In both first and subsequent admissions, a pH threshold of 7.25 at 4h was associated with better prognosis (P=0.02 and P=0.04 respectively). In second or subsequent episodes of AHRF, mortality was lower and predicted only by age (P=0.002) on multivariate analysis. %26lt;br%26gt;ConclusionsNIV could be used on medical wards for patients with pH7.16 or greater on their first admission, although more conservative values should continue to be used for those with a second or subsequent episodes of AHRF. %26lt;br%26gt;NIV is increasingly used in patients with COPD exacerbations outside an ICU setting. We show that patients with a lower pre-NIV pH(7.15-7.25) do as well as those with a higher pH, potentially advocating its use in a relatively low intensity setting of a respiratory ward-based NIV unit as opposed to a Critical Care Unit. Future guidelines should to take this into account.

• 出版日期2014-11
• 单位河北医科大学