Abstract
Background A recent study has shown that COPD patients with acute hypercapnic respiratory failure, who require invasive mechanical ventilation (IMV) after failure of non-invasive ventilation (NIV), experience high mortality rates, up to 30% (Chandra et al. Am J Respir Crit Care Med 2012;185:152-9).Predictors of NIV failure have been well studied in the Intensive Care Unit, but are less clear for Emergency Department (ED) presentation. Early recognition in the ED is necessary to select appropriate NIV candidates.
Objective To determine parameters, specific for ED presentation, associated with transition from NIV to IMV due to NIV failure.
MethodsThis is a 4-year retrospective study in the ED's of two Dutch hospitals. By International Classification of Disease codes 139 COPD patients treated with NIV, were identified. Those with AHRF (pH limits: 7.25-7.35), full resuscitation order, without a pneumonia, were selected for the study (n=40 with 50 NIV episodes). Parameters in patients, successfully treated with NIV, were compared with those in patients requiring transition to IMV. Univariable regression analysis was used and variables with a p-value < 0.20 were entered into a multivariable logistic regression analysis.
ResultsNIV was successful in 33(66%) patients, 10(20%) patients needed transition to IMV and 7(14%) patients died.Age above 65 years and a Glasgow Coma Score (GCS) less than 15 at ED presentation were significantly associated with transition from NIV to IMV in multivariable analysis (p<0,05).
ConclusionA high age and a low GCS, at ED presentation, are factors associated with transition from NIV to IMV, in patients with ARF due to exacerbation of COPD.
- © 2014 ERS