Venkatnarayan Kavitha, Khilnani Gopi C, Hadda Vijay, Madan Karan, Mohan Anant, Pandey Ravindra M, Guleria Randeep
Department of Pulmonary Medicine, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Lung India. 2020 Jan-Feb;37(1):3-7. doi: 10.4103/lungindia.lungindia_335_19.
The optimal strategy for the withdrawal of noninvasive ventilation (NIV) remains unknown. This study was planned to compare three different strategies for the withdrawal of NIV among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnic respiratory failure (HcRF).
Patients with AECOPD with HcRF who improved on NIV were randomized into three groups - immediate withdrawal (Group A), stepwise reduction of pressure support (Group B), and stepwise reduction of duration (Group C) of NIV. The probability of successful withdrawal was compared among the groups.
This study included 90 patients (males - 86.6%) with a mean (±standard deviation [SD]) age of 59.9 ± 8.3 years. The mean (±SD) pH and PaCO at admission were 7.23 ± 0.04 and 84.4 ± 12.0 mm Hg, respectively. The duration of NIV received before randomization was 31.6 ± 9.2 h with maximum inspiratory positive airway pressure and expiratory positive airway pressure of 17.6 ± 2.7 cm HO and 7.4 ± 1.4 cm HO, respectively. NIV was successfully withdrawn in 23/30 (76.6%) in Group A, 27/30 (90%) in Group B, and 26/30 (86.6%) in Group C (P = 0.31). The total duration of NIV use and length of hospital stay was lower in Group A and B as compared to Group C (P = 0.001).
Immediate withdrawal of the NIV after recovery of respiratory failure among patients with exacerbation of COPD is feasible. Immediate withdrawal did not increase the risk of weaning failure from the NIV.
无创通气（NIV）撤离的最佳策略仍不明确。本研究旨在比较慢性阻塞性肺疾病急性加重（AECOPD）合并高碳酸血症呼吸衰竭（HcRF）患者中三种不同的NIV撤离策略。
NIV治疗后病情改善的AECOPD合并HcRF患者被随机分为三组——立即撤离组（A组）、逐步降低压力支持组（B组）和逐步缩短NIV持续时间组（C组）。比较各组成功撤离的概率。
本研究纳入90例患者（男性占86.6%），平均（±标准差[SD]）年龄为59.9±8.3岁。入院时平均（±SD）pH值和动脉血二氧化碳分压分别为7.23±0.04和84.4±12.0 mmHg。随机分组前接受NIV的持续时间为31.6±9.2小时，最大吸气气道正压和呼气气道正压分别为17.6±2.7 cm H₂O和7.4±1.4 cm H₂O。A组30例中有23例（76.6%）成功撤离NIV，B组30例中有27例（90%），C组30例中有26例（86.6%）（P = 0.31）。与C组相比，A组和B组的NIV总使用时间和住院时间更短（P = 0.001）。
COPD加重患者呼吸衰竭恢复后立即撤离NIV是可行的。立即撤离不会增加NIV撤机失败的风险。
