Prediccion de fracaso en ventilacion mecanica no invasiva en falla respiratoria en enfermedad pulmonar obstructiva cronica a grandes alturas Academic Article

abstract

  • Management with non-invasive mechanical ventilation (NIMV) in exacerbations of chronic obstructivepulmonary disease (COPD) reduces the need for intubation and the associated complications. It istherefore indicated in clinical settings of acute respiratory failure. The gasometric variables describedat sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level).The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy)and to describe the variables at admission associated with failure in patients with exacerbationof COPD and respiratory failure that require management in the intensive care unit (ICU).METHODS: a retrospective cohort was analyzed; clinical characteristics, severity scores, and gasometricvalues were registered. The differences between the success and failure groups were evaluated.A logistic regression analysis was applied to explore factors associated with outcome.RESULTS: 158 patients were included; 54,5% were women; the mean age was 74,3±8,8 years.Characteristics at admission: APACHE 17,1±4,1, PaCO2 52,7±14,9 mm Hg, PaO2/FIO2 166,6±61,1,pH 7,32±0,09, FC 104,4±23,1. Management with BiPAP: 93%, CPAP: 7%. NIMV failed in 24,1%(orotracheal intubation: 15,8%, tracheostomy: 6,3%, and mortality: 12%). On multivariate analysis,the variables associated with failure were: APACHE ≥17 (OR: 2,34 [1,04-5,3]) and PaCO2≥55 (OR:2,47 [1,08-5,79]). There was no association with sex or PaO2/FIO2.CONCLUSIONS: the percentage of failure with NIMV (24,1%) was less than that reported in the internationalliterature. The risk factors found (high APACHE and PaCO2) are confirmed as predictors offailure in NIMV, and are applicable to Bogotá or similar altitudes. High altitudes do not appear to haveinfluence on the outcomes of patients with COPD exacerbations that require management in an ICU.

publication date

  • 2013/1/1

edition

  • 13

keywords

  • APACHE
  • Artificial Respiration
  • Chronic Obstructive Pulmonary Disease
  • Colombia
  • Disease Progression
  • Intensive Care Units
  • Intubation
  • Logistic Models
  • Mortality
  • Multivariate Analysis
  • Noninvasive Ventilation
  • Oceans and Seas
  • Regression Analysis
  • Respiratory Insufficiency
  • Tracheostomy

International Standard Serial Number (ISSN)

  • 0122-7262

number of pages

  • 5

start page

  • 12

end page

  • 17