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Noninvasive Mechanical Ventilation in Acute Hypercapnic Respiratory Failure Is Not Just a Problem for COPD Patients FREE TO VIEW

Carolina Gotera, MD; Patricia Lazo Meneses, MD; Deisy Barrios Barreto, MD; Patricia Castro Acosta, MD; Rosa Mirambeaux Villalona, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD; Esteban Perez Rodriguez, PhD; Jonathan Cámara Fernández, MD
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Ramon y Cajal Hospital, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):553A. doi:10.1378/chest.1824428
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SESSION TITLE: Non-Invasive Ventilation

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 12:15 PM - 01:15 PM

PURPOSE: The objective is evaluated our experience, use and results of non-invasive ventilation (NIV) in COPD (chronic obstructive pulmonary disease) and non-COPD patients with hypercapnic acidosis

METHODS: A retrospective observational study which analyzes all patients evaluated by the pneumology department in Ramon y Cajal Hospital, treated with non-invasive ventilation secondary a hypercapnic respiratory acidosis. Were analyzed two groups of patients according to underlying diagnosis the COPD and non-COPD. Both groups are compared according to general characteristics and results obtained (pH correction, improvement in level of consciousness, hospital mortality). The exclusion criteria were restrictive respiratory failure (neuromuscular, obesity-hypoventilation syndrome (OHS) and thoracic cage disease).

RESULTS: A total of 1,154 patients were analyzed between 2008 and 2012, respectively. Of these, 450 (38.9%) were COPD and 704 (61.1%) non-COPD. Of the non-COPD patients: 70% have multiple comorbidities, 15% congestive heart failure, 10% treated with central nervous system depressant drugs and 5% other causes. The mean age in non-COPD patients was higher (85 years ± 6.3 vs. 65 ± 12.1 respectively). In analytical results, the pH and partial pressure of carbon dioxide (pCO2) in arterial blood gases was significantly higher in non-COPD (initial pH 7.10 ± 2.3 in non-COPD vs. initial pH 7.21 ± 4 in COPD) (initial pCO2 in non-COPD was 95 mmHg ± 20 vs. 76 mmHg ± 12.5 in COPD group). After one hour of treatment, we observe a early correction and significant clinical improvement and greater tolerance in non-COPD compared with the other group. The mortality and the indication of domiciliary non-invasive ventilation were lower in COPD patients compared to the non-COPD patient

CONCLUSIONS: The non-invasive mechanical ventilation is an effective and well tolerated treatment option for hypercapnic respiratory acidosis in elderly people with multiple comorbidities non-COPD. In our study, the use of NIV was more frequent in COPD patients. The non-COPD patients have more degree of acidosis however the treatment response is better. In our experience, the 40% of these patients have non-invasive ventilation at home and in the monitoring we observed a decrease in the number of hospital admissions or emergency visit with improved quality of life

CLINICAL IMPLICATIONS: Provide new lines of treatment in patients with acute hypercapnic respiratory failure, non-COPD

DISCLOSURE: The following authors have nothing to disclose: Carolina Gotera, Patricia Lazo Meneses, Deisy Barrios Barreto, Patricia Castro Acosta, Rosa Mirambeaux Villalona, Salvador Diaz Lobato, Sagrario Mayoralas Alises, Esteban Perez Rodriguez, Jonathan Cámara Fernández

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