Briones-Claudett Killen H, Romero Lopez Adela, Briones-Claudett Mónica H, Cabrera Baños Mariuxi Del Pilar, Briones Zamora Killen H, Briones Marquez Diana C, Icaza-Freire Andrea P, Zimmermann Luc J I, Gavilanes Antonio W D, Grunauer Michelle
Universidad de Guayaquil, Facultad de Ciencias Médicas, Guayaquil, Ecuador.
Physiology and Respiratory-Center Briones-Claudett, Guayaquil, Ecuador.
Crit Care Res Pract. 2021 Nov 27;2021:7793657. doi: 10.1155/2021/7793657. eCollection 2021.
This study intends to determine the Apnea-Hypopnea Index in patients hospitalized with acute hypercapnic respiratory failure from chronic obstructive pulmonary disease exacerbation, who require noninvasive ventilation with average volume-assured pressure support (AVAPS), as well as describes the clinical characteristics of these patients.
We designed a single-center prospective study. The coexistence of Apnea-Hypopnea Index and clinical, gasometric, spirometric, respiratory polygraphy, and ventilatory characteristics were determined. The clinical characteristics found were categorized and compared according to the Apnea-Hypopnea Index (AHI) < 5, AHI 5-15, and AHI >15. A value <0.05 was considered statistically significant.
During the study period, a total of 100 patients were admitted to the ICU with a diagnosis of acute hypercapnic respiratory failure due to COPD exacerbation. 72 patients presented with acute respiratory failure and fulfilled criteria for ventilatory support. Within them, 24 received invasive mechanical ventilation and 48 NIV. After applying the inclusion criteria for this study, 30 patients were eligible. An AHI >5 was present in 24 of the 30 patients recruited (80%). Neck circumference (cm), Epworth scale, and Mallampati score evidenced significant differences when compared to the patient's AHI <5, AHI 5-15, and AHI >15 ( < 0.05). Furthermore, patients with an AHI >5 had longer hospital admissions, prolonged periods on mechanical ventilation, and a higher percentage of intubation rates.
Apnea-Hypopnea Index and chronic obstructive pulmonary disease exacerbation are a frequent association found in patients with acute hypercapnic respiratory failure and COPD exacerbations that require NIV. This association could be a determining factor in the response to NIV, especially when AVAPS is used as a ventilatory strategy.
本研究旨在确定因慢性阻塞性肺疾病急性加重而住院的急性高碳酸血症呼吸衰竭患者的呼吸暂停低通气指数，这些患者需要采用平均容量保证压力支持（AVAPS）的无创通气，并描述这些患者的临床特征。
我们设计了一项单中心前瞻性研究。确定呼吸暂停低通气指数与临床、气体分析、肺功能、呼吸多导记录和通气特征的共存情况。根据呼吸暂停低通气指数（AHI）<5、AHI 5 - 15和AHI>15对所发现的临床特征进行分类和比较。P值<0.05被认为具有统计学意义。
在研究期间，共有100例因慢性阻塞性肺疾病急性加重而诊断为急性高碳酸血症呼吸衰竭的患者入住重症监护病房。72例患者出现急性呼吸衰竭并符合通气支持标准。其中，24例接受有创机械通气，48例接受无创通气。应用本研究的纳入标准后，30例患者符合条件。在招募的30例患者中，24例（80%）的AHI>5。与AHI<5、AHI 5 - 15和AHI>15的患者相比，颈围（cm）、爱泼沃斯量表和马兰帕蒂评分存在显著差异（P<0.05）。此外，AHI>5的患者住院时间更长，机械通气时间延长，插管率更高。
呼吸暂停低通气指数与慢性阻塞性肺疾病急性加重在需要无创通气的急性高碳酸血症呼吸衰竭和慢性阻塞性肺疾病急性加重患者中经常同时出现。这种关联可能是影响无创通气反应的一个决定性因素，尤其是当采用平均容量保证压力支持作为通气策略时。
