PURPOSE: Non invasive ventilation (NIV) has proved to be effective in patients with severe COPD exacerbations, however its usefulness is not so much studied in other types of acute chronic respiratory failure (CRF-A) such as morbid obesity related to alveolar hypoventilation syndrome (MO/AHS).
METHODS: Prospective observational study including all patients admitted with CRF-A from January 1997 to December 2005. The indication for NIV was dyspnea, respiratory rate >30, PaO2/FiO2 <200, pHa <7.35 or respiratory accessory muscular activity. The primary goal was to determine the success of NPPV (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 hours on a medical ward). The secondary goal was to identify the variables that can predict NPPV therapy failure and hospital mortality.
RESULTS: 535 patients have been analyzed, 403 COPD and 132 MO/AHS. Main variables in both types of patients are in Table I. Variables associated to NIV failure were: PaO2/FiO2 admission (OR:0.964, CI-95%:0.964 to 0.948; p<0.001), PaO2/FiO2 1 hour-NIV (OR:0.949, CI-95%:0.931 to 0.965; p<0.001), respiratory rate 1hour-NIV (OR:1.063, CI-95%:1.004 to 1.125, p:0.035), PaCO2 1 hour-NIV (OR:1.023, CI-95%:1.006 to 1.040, p:0.006) and SOFA maximum (OR:1.626, CI-95%:1.438 to 1.838, p<0.001).
CONCLUSION: NIV may be used successfully in COPD patients as well as in MO/AHS patients with acute exacerbation of chronic respiratory failure.
CLINICAL IMPLICATIONS: We can treat acute exhacerbations of MO/HAS patients with NIV expecting a high sucess rate.
DISCLOSURE: Antonio Esquinas, None.