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Clinical Investigations in Critical Care |

Noninvasive Positive-Pressure Ventilation To Treat Hypercapnic Coma Secondary to Respiratory Failure*

Gumersindo Gónzalez Díaz, MD; Andres Carrillo Alcaraz, MD; Juan Carlos Pardo Talavera, MD; Pedro Jara Pérez, MD; Antonio Esquinas Rodriguez, MD; Francisco García Cordoba, MD; Nicholas S. Hill, MD, FCCP
Author and Funding Information

*From the Intensive Care Unit (Drs. Gónzalez Díaz, Carrillo Alcaraz, Pardo Talavera, Jara Pérez, Esquinas Rodriguez, and García Cordoba), Hospital JM Morales Meseguer, Murcia, Spain; and Pulmonary, Critical Care, and Sleep Division (Dr. Hill), Tufts-New England Medical Center, Boston, MA.

Correspondence to: Gumersindo Gónzalez Díaz, MD, Intensive Care Unit. Hospital Morales Meseguer, C/Marqués de los Velez s/n, 30008 Murcia, Spain; e-mail: gumersindoj.gonzalez@carm.es



Chest. 2005;127(3):952-960. doi:10.1378/chest.127.3.952
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Introduction: Hypercapnic coma secondary to acute respiratory failure (ARF) is considered to be a contraindication to the use of treatment with noninvasive positive-pressure ventilation (NPPV). However, intubation exposes these patients to the risk of complications such as nosocomial pneumonia, sepsis, and even death.

Patients and methods: We performed a prospective, open, noncontrolled study to assess the outcomes of NPPV therapy in patients with a Glasgow coma scale (GCS) score of ≤ 8 points due to ARF. The primary goal of the study was to determine the success of NPPV therapy (defined as a response to therapy allowing the patient to avoid endotracheal intubation, and to survive a stay in the ICU and at least 24 h on a medical ward) in patients with hypercapnic coma, compared to those who started NPPV therapy while awake. The secondary goal of the study was to identify the variables that can predict a failure of NPPV therapy in these patients.

Results: A total of 76 coma patients (80%) responded to NPPV therapy, and 605 patients with GCS scores > 8 responded to therapy (70%; p = 0.04). A total of 25 coma patients died in the hospital (26.3%), and 287 noncoma patients died in the hospital (33.2%; p = 0.17). The variables related to the success of NPPV therapy were GCS score 1 h posttherapy (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.53 to 3.53) and higher levels of multiorgan dysfunction, as measured by the maximum sequential organ failure assessment index score reached during NPPV therapy (OR, 0.72; 95% CI, 0.55 to 0.92).

Conclusions: We concluded that selected patients with hypercapnic coma secondary to ARF can be treated as successfully with NPPV as awake patients with ARF.


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