Lemyze Malcolm, Bury Quentin, Guiot Aurélie, Jonard Marie, Mohammad Usman, Van Grunderbeeck Nicolas, Gasan Gaelle, Thevenin Didier, Mallat Jihad
Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens.
Intensive Care Unit, Arras Hospital, Arras.
Int J Chron Obstruct Pulmon Dis. 2017 May 25;12:1539-1547. doi: 10.2147/COPD.S136241. eCollection 2017.
We evaluated a new noninvasive ventilation (NIV) protocol that allows the pursuit of NIV in the case of persistent severe respiratory acidosis despite a first NIV challenge in COPD patients with acute hypercapnic respiratory failure (AHRF).
A prospective observational multicentric pilot study was conducted in three tertiary hospitals over a 12-month study period. A total of 155 consecutive COPD patients who were admitted for AHRF and treated by NIV were enrolled. Delayed response to NIV was defined as a significant clinical improvement in the first 48 h following NIV initiation despite a persistent severe respiratory acidosis (pH <7.30) after the first 2 h of NIV trial.
NIV failed in only 10 patients (6.5%). Delayed responders to NIV (n=83, 53%) exhibited similar nutritional status, comorbidities, functional status, frailty score, dyspnea score, and severity score at admission, compared with early responders (n=62, 40%). Only age (66 vs 70 years in early responders; =0.03) and encephalopathy score (3 [2-4] vs 3 [2-4] in early responders; =0.015) were different among the responders. Inhospital mortality did not differ between responders to NIV (n=10, 12% for delayed responders vs n=10, 16% for early responders, =0.49). A second episode of AHRF occurred in 20 responders (14%), equally distributed among early and delayed responders to NIV (n=9, 14.5% in early responders vs n=11, 13% in delayed responders; =0.83), with a poor survival rate (n=1, 5%).
Most of the COPD patients with AHRF have a successful outcome when NIV is pursued despite a persistent severe respiratory acidosis after the first NIV trial. The outcome of delayed responders is similar to the one of the early responders. On the contrary, the second episode of AHRF during the hospital stay carries a poor prognosis.
我们评估了一种新的无创通气（NIV）方案，该方案适用于慢性阻塞性肺疾病（COPD）合并急性高碳酸血症呼吸衰竭（AHRF）的患者，尽管在首次NIV治疗后仍存在持续性严重呼吸性酸中毒，但仍可继续进行NIV治疗。
在三家三级医院进行了一项为期12个月的前瞻性观察性多中心试点研究。共纳入155例因AHRF入院并接受NIV治疗的连续COPD患者。NIV延迟反应定义为在NIV开始后的前48小时内临床有显著改善，尽管在NIV试验的前2小时后仍存在持续性严重呼吸性酸中毒（pH<7.30）。
仅10例患者（6.5%）NIV治疗失败。与早期反应者（n=62，40%）相比，NIV延迟反应者（n=83，53%）在入院时的营养状况、合并症、功能状态、衰弱评分、呼吸困难评分和严重程度评分相似。反应者之间仅年龄（早期反应者为66岁，延迟反应者为70岁；P=0.03）和脑病评分（早期反应者为3[2-4]，延迟反应者为3[2-4]；P=0.015）不同。NIV反应者的住院死亡率无差异（延迟反应者为10例，12%；早期反应者为10例，16%；P=0.49）。20例反应者（14%）发生了第二次AHRF发作，在NIV早期反应者和延迟反应者中分布相同（早期反应者为9例，14.5%；延迟反应者为11例，13%；P=0.83），生存率较低（n=1，5%）。
大多数COPD合并AHRF的患者，尽管在首次NIV试验后仍存在持续性严重呼吸性酸中毒，但继续进行NIV治疗仍可取得成功结果。延迟反应者的结果与早期反应者相似。相反，住院期间第二次AHRF发作的预后较差。
