[Application of pulmonary infection control window as switching point for sequential invasive to noninvasive ventilation in treatment of severe respiratory failure of chronic obstructive pulmonary disease: a randomized controlled study].

OBJECTIVE

To evaluate the feasibility and the efficacy of early extubation and sequential noninvasive mechanical ventilation (MV) switched by pulmonary infection control window (PIC window) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.

METHODS

Respiratory or Medical Intensive Care Units (RICU/MICU) of 12 teaching hospitals in China participated in this study. COPD patients with severe hypercapnic respiratory failure exacerbated by pulmonary infection, and for whom intubation and MV were indicated, were enrolled in the study. PIC window was defined as the time point when pulmonary infection was considered under control based on clinical parameters. At PIC window, all the cases were randomly assigned to sequential MV group or conventional MV group. The invasive MV duration, ventilator-associated pneumonia (VAP), days in ICU and mortality rate in both groups were measured.

RESULTS

Ninety cases were enrolled. Compared with conventional MV group (n = 43) sequential MV group (n = 47) had shorter duration of invasive MV [(6.4 +/- 4.4), (11.3 +/- 6.2) d, P = 0.000], lower rate of VAP (3/47, 12/43, P = 0.014), fewer days in ICU [(12 +/- 8), (16 +/- 11) d, P = 0.047] and lower mortality rate (1/47, 7/43, P = 0.025).

CONCLUSION

Early extubation followed by non-invasive MV initiated at the point of PIC window may decrease the duration of invasive MV and improve the prognosis.