Chest
Clinical Investigations in Critical CarePredicting the Result of Noninvasive Ventilation in Severe Acute Exacerbations of Patients With Chronic Airflow Limitation
Section snippets
Materials and Methods
The study was carried out between February 1995 and March 1998. In the first part of the study, 44 consecutive episodes of acute hypercapnic respiratory failure in 34 patients with an earlier diagnosis of CAFL were studied. They had not had previous treatment with NIV at home, were admitted to our hospital because of acute exacerbations of their condition, and were considered candidates for the study. Initially, all received conventional treatments,1, 23, 4 including bronchodilators,
Results
NIV was used to successfully treat 46 of 59 episodes (77%) of acute respiratory failure in the 49 patients included in the two consecutive parts of our study. The data related to clinical symptoms and lung function variables of 44 episodes of acute hypercapnic failure in the 34 patients included in the first part of the study are shown in Table 1. Their clinical status before and after 1 h of NIV is summarized in Table 2. In 34 of the 44 episodes (77%), OTI was avoided and the outcome was
Discussion
NIV has been used successfully to treat acute exacerbations of CAFL13, 1516, 1718, 1920, 2122, 2325, 2627 and has reduced the OTI and mortality rates in such patients who have severe acidosis.17, 18 In our study, 77% of patients were successfully treated with NIV in our conventional respiratory medicine ward, a proportion similar to that of studies performed in ICUs.13, 1920, 2325, 26 However, in some patients NIV is known to be ineffective.18, 27 Better screening criteria, based on predictive
ACKNOWLEDGMENT
We thank M. E. Kerans for the English translation and editing of the manuscript.
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