Diferencia entre revisiones de «EBQ:NIPPV in COPD»
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Both groups received: subcutaneous heparin, antibiotics, and bronchodilators (subcutaneous terbutaline, aerosolized and intravenous albuterol, and corticosteroids or intravenous aminophylline or both), electrolyte corrections. | Both groups received: subcutaneous heparin, antibiotics, and bronchodilators (subcutaneous terbutaline, aerosolized and intravenous albuterol, and corticosteroids or intravenous aminophylline or both), electrolyte corrections. | ||
Standard group: | 1) Standard group: | ||
Supp O2 to max 5L NC to keep arterial O2Sat >90% | Supp O2 to max 5L NC to keep arterial O2Sat >90% | ||
NIPPV group: | 2) NIPPV group: | ||
At least 6hours daily of NIPPV by ARM 25 machine keep arterial O2Sat >90%. Duration of noninvasive ventilation was determined on the basis of clinical criteria and arterial-blood gas levels. | At least 6hours daily of NIPPV by ARM 25 machine keep arterial O2Sat >90%. Duration of noninvasive ventilation was determined on the basis of clinical criteria and arterial-blood gas levels. | ||
Hard criteria for Intubation in either group: | |||
o respiratory arrest | |||
o respiratory pauses with loss of consciousness or gasping for air, psychomotor agitation | |||
o making nursing care impossible and requiring sedation | |||
o a heart rate below 50 bpm with loss of alertness | |||
o hemodynamic instability with systolic arterial blood pressure below 70 mm Hg. | |||
In NIPPV group if a criterion was present after the withdrawal of ventilatory support, it could be reintroduced. If the criterion persisted after ventilation had been resumed, intubation was performed ** | |||
==Outcomes== | ==Outcomes== | ||
Revisión del 22:33 3 feb 2014
PubMed Full text PDF
Clinical Question
Can NIPPV be used to avoid endotracheal intubation in acute COPD exacerbation?
Conclusion
NIPPV could avoid endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate in the selected patients.
Major Points
Guidelines
Design
Multicenter prospective randomized trial at five hospitals
Population
Adult patients with known or suspected COPD (by history, exam or CXR).
Inclusion Criteria
Respiratory acidosis/elevated HCO3 with exacerbation of dyspnea lasting less than two weeks. And at least two of the following:
- a respiratory rate above 30 bpm
- PaO2 <45 mm Hg
- Arterial pH < 7.35 after 10min RA
Exclusion Criteria
- RR < 12 bmp or need for immediate intubation (as defined below)
- tracheotomy or endotracheal intubation performed before admission
- the administration of sedative drugs within the previous 12 hrs
- CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia
- cardiac arrest (within previous 5 days)
- cardiogenic pulmonary edema;
- kyphoscoliosis as the cause of chronic respiratory failure or a neuromuscular disorder
- upper airway obstruction or asthma
- a clear cause of decompensation requiring specific treatment (e.g., peritonitis, septic shock, acute myocardial infarction, pulmonary thromboembolism, pneumothorax, hemoptysis, severe pneumonia, or recent surgery or trauma); a facial deformity; or enrollment in other investigative protocols.
- Refusal to undergo endotracheal intubation
Interventions
Both groups received: subcutaneous heparin, antibiotics, and bronchodilators (subcutaneous terbutaline, aerosolized and intravenous albuterol, and corticosteroids or intravenous aminophylline or both), electrolyte corrections.
1) Standard group:
Supp O2 to max 5L NC to keep arterial O2Sat >90%
2) NIPPV group:
At least 6hours daily of NIPPV by ARM 25 machine keep arterial O2Sat >90%. Duration of noninvasive ventilation was determined on the basis of clinical criteria and arterial-blood gas levels.
Hard criteria for Intubation in either group: o respiratory arrest
o respiratory pauses with loss of consciousness or gasping for air, psychomotor agitation
o making nursing care impossible and requiring sedation
o a heart rate below 50 bpm with loss of alertness
o hemodynamic instability with systolic arterial blood pressure below 70 mm Hg.
In NIPPV group if a criterion was present after the withdrawal of ventilatory support, it could be reintroduced. If the criterion persisted after ventilation had been resumed, intubation was performed **