A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation

被引:246
作者
Confalonieri, M
Garuti, G
Cattaruzza, MS
Osborn, JF
Antonelli, M
Conti, G
Kodric, M
Resta, O
Marchese, S
Gregoretti, C
Rossi, A
机构
[1] Ospedale Cattinara, I-34100 Trieste, Italy
[2] Osped Riuniti Trieste, Trieste, Italy
[3] Ospedale Mirandola, Unit Pneumol, Modena, Italy
[4] Univ Roma La Sapienza, Dipartimento Sanita Pubbl, Rome, Italy
[5] Univ S Cuore, Ist Anestesia & Rianimaz, Rome, Italy
[6] Univ Bari, Inst Malattie Apparato Respiratorio, Bari, Italy
[7] Ospedale Civ, Div Pneumol, Palermo, Italy
[8] CTO, Serv Anestesia & Rianimaz, Turin, Italy
[9] Osped Riuniti Bergamo, Div Pneumol, I-24100 Bergamo, Italy
关键词
chronic obstructive pulmonary disease; endotracheal intubation; noninvasive ventilation; respiratory failure;
D O I
10.1183/09031936.05.00085304
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Knowing the likelihood of failure of noninvasive positive pressure ventilation (NPPV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD) could indicate the best choice between NPPV and endotracheal intubation instituted earlier. For this purpose, two risk charts were designed (at admission and after 2 h of NPPV) that included all relevant measurable clinical prognostic indicators derived from a population representing the patients seen routinely in clinical practice. Risk stratification of NPPV failure was assessed in 1,033 consecutive patients admitted to experienced hospital units, including two intensive care units, six respiratory intermediate care units, and five general wards. NPPV was successful in 797 patients. Patients with a Glasgow Coma Score <11, acute physiology and chronic health evaluation (APACHE) II greater than or equal to29, respiratory rate greater than or equal to30 breaths(.)min(-1) and pH at admission <7.25 have a predicted risk of failure >70%. A pH <7.25 after 2 h greatly increases the risk (>90%). The risk charts were validated on an independent group of 145 consecutive COPD patients treated with NPPV due to an acute ventilatory failure episode. To identify patients with a probability of failure >50%, the sensitivity and specificity were 33% and 96.7% on admission and 52.9% and 94.1% after 2 h of NPPV, respectively. The prediction chart, based on data from the current study, can function as a simple tool to predict the risk of failure of noninvasive positive pressure ventilation and thus improve clinical management of patients tailoring medical intervention.
引用
收藏
页码:348 / 355
页数:8
相关论文
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