Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Top 10 Papers in 2020
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • Call for Abstracts 2021
    • 2020 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Top 10 Papers in 2020
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • Call for Abstracts 2021
    • 2020 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Follow aarc on Twitter
  • Visit aarc on Facebook
LetterCorrespondence

Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: Is It the Same as in Hypercapnic Coma?

Killen H Briones Claudett
Respiratory Care April 2014, 59 (4) e60; DOI: https://doi.org/10.4187/respcare.03128
Killen H Briones Claudett
Department of Respiratory Medicine Panamericana Clinic Department of Respiratory Medicine-Intensive Care Santa Maria Clinic Pulmonology Department Military Hospital Guayaquil, Ecuador
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor:

I have read with interest the original article entitled, “Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit.”1 In this paper, the authors prospectively evaluated 242 patients who received noninvasive ventilation (NIV) for acute hypercapnic respiratory failure in the presence of COPD or other causes not associated with COPD and for acute hypercapnic respiratory failure in the absence of chronic obstructive diseases. The authors found severe hypoxemia as an independent factor of failure in hypercapnic patients from any source. Alterations at the sensory level have been reported, and ventilatory settings do not influence the results.

I have some remarks on this study. The authors reported 31 (12.8% of all patients studied) hypercapnic coma patients either on admission (15 patients) or during the first 24 h (16 patients). The management of hypercapnic coma patients, which can be measured by the Glasgow coma scale2 and the Kelly-Matthay scale,3 differs from that of patients with an altered level of consciousness who have not reached hypercapnic coma, especially regarding the levels of pressure support used during the first hours or target volume.

The authors found no significant differences in the levels of pressure used between the two groups, with a support pressure of 9.2 ± 2.6 cm H2O (NIV success) versus 9.4 ± 2.8 (NIV failure). Díaz et al4 used BiPAP Vision or BiPAP S/T-D 30 (Philips Respironics, Murrysville, Pennsylvania), and inspiratory positive airway pressure (IPAP) was initially programmed at 12 cm H2O and increased every 4 h, with an IPAP in the first hour of 17 ± 2 cm H2O. Briones Claudett et al5 reported an IPAP baseline of 19.82 in the bi-level positive airway pressure spontaneous/timed (BPAP S/T) group with average volume-assured pressure support. Therefore, the use of pressure levels in this study in hypercapnic coma patients must be considered independently of the pressure levels used in patients with impaired sensory level that are without hypercapnic coma because levels may be below those routinely used in daily practice.6,7 In contrast, an underestimation of pressure support or IPAP levels in this subgroup of patients may affect early clearance of PCO2 in the blood and especially in the cerebrospinal fluid, prolonging coma and maintaining intubation risk for these patients. Furthermore, the authors found no significant differences in the tidal volume (VT): 475 ± 140 (NIV success) versus 415 ± 166.06 (NIV failure).

We found a significant improvement in quick minute volume in patients with hypercapnic coma6 with rapid recovery of sensory level comparing the BPAP S/T-only group versus the BPAP S/T with average volume-assured pressure support group (BPAP S/T-only, 304 ± 60.6 vs 531.1 ± 63.6; BPAP S/T with average volume-assured pressure support, 298.6 ± 54.3 vs 617.6 ± 77.4; P = .01).

The rapid recovery of sensory level in these patients is also linked to an improvement in the exhaled VT, which quickly reaches the levels required to maintain an appropriate VT and correct hypoventilation, improving alveolar ventilation. The presence of secretions, which are essential in evaluating the failure prevention technique and endotracheal intubation, has not been evaluated. We believe that these assessments should be taken into account when analyzing these results.

Footnotes

  • The author has disclosed no conflicts of interest.

  • Copyright © 2014 by Daedalus Enterprises

REFERENCES

  1. 1.↵
    1. Contou D,
    2. Fragnoli C,
    3. Córdoba-Izquierdo A,
    4. Boissier F,
    5. Brun-Buisson C,
    6. Thille AW
    . Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit. Respir Care 2013;58(12):2045-2052.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Scala R,
    2. Naldi M,
    3. Archinucci I,
    4. Coniglio G,
    5. Nava S
    . Noninvasive positive pressure ventilation in patients with acute exacerbation of COPD and varying levels of consciousness. Chest 2005;128(3):1657-1666.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Scala R,
    2. Nava S,
    3. Conti G,
    4. Antonelli M,
    5. Naldi M,
    6. Archinucci I,
    7. et al
    . Noninvasive versus conventional ventilation to treat hypercapnic encephalopathy in chronic obstructive pulmonary disease. Intensive Care Med 2007;33(12):2101-2108
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Díaz GG,
    2. Alcaraz AC,
    3. Talavera JC,
    4. Pérez PJ,
    5. Rodriguez AE,
    6. Cordoba FG,
    7. Hill NS
    . Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure. Chest 2005;127(3):952-960.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Briones Claudett KH,
    2. Briones Claudett M,
    3. Chung Sang Wong M,
    4. Nuques Martinez A,
    5. Soto Espinoza R,
    6. Montalvo M,
    7. et al
    . Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy. BMC Pulm Med 2013;13:12
    OpenUrlPubMed
  6. 6.↵
    1. Elliott MW
    . High inspiratory pressures are tolerated by patients with acute COPD requiring noninvasive ventilation. Eur Respir J 2009;34(S53):39s.
    OpenUrl
  7. 7.↵
    Royal College of Physicians, British Thoracic Society, Intensive Care Society. Non-invasive ventilation in chronic obstructive pulmonary disease: mangement of acute type 2 respiratory failure. Concise Guidance to Good Practice, No 11. London: Royal College of Physicians; 2008. http://www.rcplondon.ac.uk/resources/concise-guidelines-non-invasive-ventilation-chronic-obstructive-pulmonary-disease
PreviousNext
Back to top

In this issue

Respiratory Care: 59 (4)
Respiratory Care
Vol. 59, Issue 4
1 Apr 2014
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: Is It the Same as in Hypercapnic Coma?
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: Is It the Same as in Hypercapnic Coma?
Killen H Briones Claudett
Respiratory Care Apr 2014, 59 (4) e60; DOI: 10.4187/respcare.03128

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: Is It the Same as in Hypercapnic Coma?
Killen H Briones Claudett
Respiratory Care Apr 2014, 59 (4) e60; DOI: 10.4187/respcare.03128
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About Us
  • Editorial Board
  • Reprints/Permissions

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire