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MINERVA PNEUMOLOGICA

A Journal on Diseases of the Respiratory System


Official Journal of the Italian Society of Thoracic Endoscopy
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Minerva Pneumologica 2003 December;42(4):201-10

language: Italian

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: prognostic factors and long term survival

Potena A., Putinati S., Ballerin L., Ritrovato L., Piattella M., Zabini F.


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Aim. Non-invasive positive pressure ventilation (NPPV) in patients with hypercapnic acute respiratory failure (HARF) due to chronic obstructive pulmonary disease (COPD) is more effective than pharmacological therapy alone. The aim of this study was to identify prognostic factors to predict the success of this technique and long term prognosis.
Methods. One hundred and sixteen consecutive patients admitted to hospital with an acute exacerbation of COPD were submitted to NPPV. Success (68,1%) or failure (31,9%) were evaluated by survival and the need for endotracheal intubation.
Results. There were no significant differences in age, sex, cause of relapse and lung function tests between the 2 groups. At enrolement 5 variables were associated with subsequent fail- ure of treatment on univariate analysis: severity of acidosis, degree of hypercapnia, low Glasgow Coma Scale (GCS) and serum albumin level, high APACHE 2 score. After 2 hours of treatment an improvement in PaCO2 level was associated with treatment success.
Conclusion. The logistic regression analysis demonstrated that, when these variables were tested together, only GCS and PaCO2 level after NPPV maintained a significant predictive effect, indicating that initial neurological deterioration and response to treatment in terms of PaCO2 reduction can be used to assess risk in a clinically meaningful fashion. The long term survival after NPPV is sufficiently good (79%) to render treatment appropriate.

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