Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo / Early Use of Noninvasive Mechanical Ventilation in Patients with Acute Hypercapnic Respiratory Failure in a Respiratory Ward: A Prospective Study

FundamentoEn los últimos años, la localización óptima de los pacientes sometidos a ventilación mecánica no invasiva (VMNI) ha sido motivo de debate. El objetivo del presente estudio fue determinar la eficacia de esta técnica en pacientes con insuficiencia respiratoria hipercápnica aguda (IRHA), ingresados en una sala de neumología y los factores asociados a su fracaso.MétodosSe evaluaron prospectivamente 69 pacientes, tratados con VMNI, ingresados en una sala de neumología. Su eficacia se definió como la ausencia de necesidad de traslado a la unidad de cuidados intensivos (UCI) con el alta hospitalaria del paciente (grupo 1), definiéndose su fracaso como la necesidad de traslado a la UCI (grupo 2).ResultadosLa edad media fue significativamente mayor en el grupo 2. La causa de insuficiencia respiratoria fue una enfermedad pulmonar obstructiva crónica (EPOC) en 51 pacientes, síndrome de obesidad-hipoventilación en 14 y cifoescoliosis en 4. La VMNI fue satisfactoria en 55 pacientes e ineficaz en 14. No se identificaron diferencias significativas entre ambos grupos para los valores pretratamiento de pH, PaCO2 y PaO2/FiO2. Después de 1 y 3h de VMNI, hubo una mejora significativa en el grupo 1. Después de 3h de VMNI, en el grupo 1, la frecuencia respiratoria disminuyó significativamente. La puntuación pretratamiento obtenida en la APACHE II, la frecuencia respiratoria, frecuencia de neumonía, complicaciones asociadas y enfermedades comórbidas fueron significativamente más altas en el grupo 2. La tasa de eficacia fue mayor en pacientes con una adhesión adecuada a la VMNI(AU)

ConclusiónLa VMNI puede aplicarse eficazmente a pacientes con IRHA ingresados en una sala de neumología. Los factores asociados a su fracaso son la ausencia de una mejora inicial de los parámetros de la gasometría y de la frecuencia respiratoria, la falta de adhesión a la VMNI, una edad más avanzada, la presencia de complicaciones asociadas, enfermedades comórbidas, neumonía y una mayor frecuencia respiratoria basal(AU)

BackgroundIn recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure.Methods69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patient's dishcarge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2).ResultsThe mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO2 and PaO2/FiO2. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV.ConclusionNIMV can be succesfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate(AU)

[Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study]. / Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo.

BACKGROUND: In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS: 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patient's discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS: The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO2 and PaO2/FiO2. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION: NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.