PURPOSE:To assess the outcome of patients with severe acute hypercapnic respiratory failure requiring mechanical ventilation (MV), but managed with NIMV.
METHODS:Patients presenting to the Vallabhbhai Patel Chest Institute, Delhi emergency room (ER) (August 2007–March 2008) in acute hypercapnic respiratory failure defined as respiratory rate (RR) > 25/min, pH < 7.35 and PaCO2 > 50 mmHg (as per GOLD guidelines- 2007) were admitted. Patients not responding to initial ER or ward management were shifted to the Intensive Care Unit (ICU). Patients with dyspnoea (RR >25/min) and pH of 7.25 –7.35 were given NIMV after consent. The patients with severe dyspnoea (RR>35/min), pH < 7.25, PaCO2 > 60 mmHg and/or altered sensorium were candidates for MV. Patients or their relatives who gave the consent received MV. However, those who refused MV consented for NIMV.
RESULTS:A total of 141 patients (115 males and 26 females) had 282 admissions in ICU. Ninety one of 141 had acute hypercapnic respiratory failure. Twenty six of 91 patients with pH 7.25–7.35 were given NIMV. Sixty five patients with pH < 7.25, PaCO2 > 60 mmHg required MV. Two of 65 patients gave consent and recovered after MV. Rest 63 patients with pH 7.18 ± 0.05 (7.05–7.24), PaCO2 111.06 ± 25.57 mmHg (71.9 –175 mmHg) refused MV, but gave consent for NIMV. Forty eight of 63 patients (76.2%) on NIMV responded clinically and had improvement in pH [7.37 ± 0.06 (7.24 - 7.49)]and PaCO2 [75.38 ± 16.02 mm Hg (45.80 –119 mm Hg)] after NIMV. Fifteen of 63 patients (23.8%) deteriorated on NIMV. Subsequently, 12 of these 15 patients’ relatives gave the consent for MV. One of 12 patients on MV expired, 11 recovered. Three who refused MV, expired.
CONCLUSION:NIMV is a promising mode of ventilation in severe acute hypercapnic respiratory failure (pH < 7.25, PaCO2 > 60 mmHg) who are otherwise candidate for MV.
CLINICAL IMPLICATIONS:In resource poor settings, NIMV can be an asset for treating severe acute hypercapnic failure.
DISCLOSURE:Rohit Caroli, No Financial Disclosure Information; No Product/Research Disclosure Information