Ansari Sheeba F, Memon Mubeen, Brohi Naveed, Tahir Amber
Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
Pulmonology, Civil Hospital, Jamshoro, PAK.
Cureus. 2019 Oct 1;11(10):e5820. doi: 10.7759/cureus.5820.
Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of poor quality of life and mortality in developing countries. Noninvasive positive pressure ventilation (NIPPV) remains the first-line intervention in hospitalized patients with acute respiratory failure (ARF) due to AECOPD. However, NIPPV may fail in some patients. This study was conducted to assess the frequency of NIPPV failure and clinical parameters and outcomes in AECOPD patients with failed NIPPV and their conversion to invasive positive pressure ventilation (IPPV). Methods This prospective observational study was conducted in the pulmonology unit of a tertiary care hospital in Pakistan. AECOPD patients with ARF who were candidates of NIPPV were included after securing informed consent. Their demographic characteristics, clinical parameters, and in-hospital outcomes were recorded on a semi-structured proforma. For statistical analysis, SPSS software version 22.0 for Windows (IBM, Armonk, NY) was used. Results With 24 hours of NIPPV, 73 (70.2%) patients improved and the remaining 31 (29.8%) were shifted to IPPV. Patients in the IPPV group had higher systolic blood pressure (BP) [133.8 mmHg (±21.2) vs. 121.1 mmHg (±8.3); probability value (p): <0.000] and lower diastolic BP [68.7 mmHg (±13.4) vs. 76.2 mmHg (±10.8); p: 0.003]. Their pH was more acidic [7.20 (±0.13) vs. 7.42 (±0.01); p: <0.000], heart rates were high [131.1 (±10.5) vs. 100.2 (±7.5); p: <0.000], and the percentage of oxygen saturation was low [90.7 (±3.0) vs. 93.4 (±4.5); p: 0.004]. Patients who were managed on NIPPV throughout their hospital stay required respiratory support for fewer days [3.2 (±1.3) vs. 4.1 (±1.8); p: 0.005], and their hospital stay was shorter [3.5 (±1.2) vs. 5.3 (±2.5) days; p: <0.000]. Mortality rate in the NIPPV group was significantly lower (1.4% vs. 12.9%; p: 0.01). Conclusions Deranged blood pressure, increased heart rate, acidemia, and a low percentage of oxygen saturation are crucial clinical and biochemical parameters that can predict the success of NIPPV with 24 hours of therapy in patients with AECOPD and secondary ARF. Patients who do not improve with 24 hours of NIPPV therapy usually have poor in-hospital outcomes including mortality.
引言
慢性阻塞性肺疾病急性加重（AECOPD）是发展中国家生活质量低下和死亡率高的主要原因。无创正压通气（NIPPV）仍然是因AECOPD导致急性呼吸衰竭（ARF）的住院患者的一线干预措施。然而，NIPPV在某些患者中可能会失败。本研究旨在评估NIPPV失败的频率、AECOPD患者NIPPV失败后的临床参数和结局，以及他们转为有创正压通气（IPPV）的情况。
方法
这项前瞻性观察性研究在巴基斯坦一家三级护理医院的肺病科进行。在获得知情同意后，纳入有ARF且适合NIPPV治疗的AECOPD患者。他们的人口统计学特征、临床参数和住院结局记录在半结构化表格上。为进行统计分析，使用了适用于Windows的SPSS软件22.0版（IBM，纽约州阿蒙克）。
结果
接受NIPPV治疗24小时后，73例（70.2%）患者病情改善，其余31例（29.8%）转为IPPV。IPPV组患者的收缩压较高[133.8 mmHg（±21.2）vs. 121.1 mmHg（±8.3）；概率值（p）：<0.000]，舒张压较低[68.7 mmHg（±13.4）vs. 76.2 mmHg（±10.8）；p：0.003]。他们的pH值更偏酸性[7.20（±0.13）vs. 7.42（±0.01）；p：<0.000]，心率较高[131.1（±10.5）vs. 100.2（±7.5）；p：<0.000]，氧饱和度百分比较低[90.7（±3.0）vs. 93.4（±4.5）；p：0.004]。在整个住院期间接受NIPPV治疗的患者需要呼吸支持的天数较少[3.2（±1.3）vs. 4.1（±1.8）；p：0.005]，住院时间较短[3.5（±1.2）vs. 5.3（±2.5）天；p：<0.000]。NIPPV组的死亡率显著较低（1.4% vs. 12.9%；p：0.01）。
结论
血压紊乱、心率加快、酸血症和低氧饱和度百分比是关键的临床和生化参数，可预测AECOPD和继发性ARF患者接受24小时NIPPV治疗的成功率。接受24小时NIPPV治疗后未改善的患者通常住院结局较差，包括死亡率。
