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Respiratory Care |

Open-Mouthpiece Ventilation in Acute Exacerbation of COPD Patients With Mild to Moderate Acidosis: A Randomized Controlled Trial

Antonello Nicolini, MD; Bruna Grecchi, RCPT
Author and Funding Information

Respiratory Diseases Unit, Sestri Levante, Italy


Chest. 2013;144(4_MeetingAbstracts):883A. doi:10.1378/chest.1690929
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Abstract

SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: The use of open mouthpiece ventilation has been well established in neuromuscular disease patients. We hypothesized that the use of this technique of ventilation could prove effective in avoiding further deterioration in patients with acute exacerbations of chronic obstructive pulmonary disease(COPD)with mild to moderate acidosis.

METHODS: The study was performed in a respiratory diseases ward. Fourteen patients with exacerbations of COPD, with a respiratory frequency > 25 a PaCO2 >45 and pH>7.20 and <7.30 and Kelly . Patients were randomly assigned to receive non- invasive ventilation (NIV) (Pressure support ventilation - PSV ) via nasal mask or open mouthpiece ventilation. The primary outcome was avoiding the transfer to more intensive setting (ICU or RICU). Arterial blood gases and respiratory rate were registered 2 hours after the start of the enrollment and then after 6,12, 24, and 48 hours. In addition duration of NIV, hospital stay and acceptability of the interfaces ( mouthpiece or nasal mask )was assessed using a Likert scale.

RESULTS: None of the patients presented deterioration of gas exchange. The two groups had similar trends in arterial blood gases and respiratory rate. No difference in duration of NIV or hospital stay were found . A significant difference in devices acceptability was found; patients preferred the mouthpiece ventilation (p<0.01)

CONCLUSIONS: Open mouthpiece ventilation is a useful technique and may prevent further deterioration of gas exchange in COPD patients with mild to moderate acidosis (similar to traditional NIV delivered by nasal mask ).

CLINICAL IMPLICATIONS: If these data are confirmed,a new and less expensive device will be available for non invasive ventilation in COPD patients.

DISCLOSURE: The following authors have nothing to disclose: Antonello Nicolini, Bruna Grecchi

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