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Abstract：
OBJECTIVE: To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a \"real-life\" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation.
METHODS: Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation).
RESULTS: 117 consecutive chronic obstructive pulmonary disease exacerbation admissions (Group A=96; Group B=13; Group C=8) of candidates for ventilatory support were reviewed. No differences in baseline disease severity and physiological parameters were found between the groups at Emergency Department admission. Nevertheless, Group B had higher intensive care unit admission, length of hospital stay, length of intensive care unit stay, and higher in-hospital mortality compared to Group A. Group C also had worse outcomes when compared to Group A. The only independent variable associated with the successful use of noninvasive positive pressure ventilation were improvement in arterial carbon dioxide pressure after 1h of noninvasive positive pressure ventilation use and its tolerance.
CONCLUSIONS: Our data confirmed in a \"real life\" Emergency Department cohort that successful management of chronic obstructive pulmonary disease exacerbation with noninvasive positive pressure ventilation showed lower in-hospital mortality and Intensive Care Unit stay when compared to patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation or patients who presented an immediate need for invasive mechanical ventilation. noninvasive positive pressure ventilation tolerance and higher arterial carbon dioxide pressure reduction after 1-h of noninvasive positive pressure ventilation were predictors of successful treatment. These results should be confirmed in a prospective randomized controlled trial.
METHODS: Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation).
RESULTS: 117 consecutive chronic obstructive pulmonary disease exacerbation admissions (Group A=96; Group B=13; Group C=8) of candidates for ventilatory support were reviewed. No differences in baseline disease severity and physiological parameters were found between the groups at Emergency Department admission. Nevertheless, Group B had higher intensive care unit admission, length of hospital stay, length of intensive care unit stay, and higher in-hospital mortality compared to Group A. Group C also had worse outcomes when compared to Group A. The only independent variable associated with the successful use of noninvasive positive pressure ventilation were improvement in arterial carbon dioxide pressure after 1h of noninvasive positive pressure ventilation use and its tolerance.
CONCLUSIONS: Our data confirmed in a \"real life\" Emergency Department cohort that successful management of chronic obstructive pulmonary disease exacerbation with noninvasive positive pressure ventilation showed lower in-hospital mortality and Intensive Care Unit stay when compared to patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation or patients who presented an immediate need for invasive mechanical ventilation. noninvasive positive pressure ventilation tolerance and higher arterial carbon dioxide pressure reduction after 1-h of noninvasive positive pressure ventilation were predictors of successful treatment. These results should be confirmed in a prospective randomized controlled trial.
摘要：
目的：根据通气支持指征，调查急诊科慢性阻塞性肺疾病急性加重患者的临床结局，并分析无创正压通气成功的潜在预测因素。
方法：在18个月内进行回顾性队列研究，比较以下患有慢性阻塞性肺疾病加重的患者组:A组由最初选择接受无创正压通气而随后不需要有创机械通气(成功-无创正压通气)的患者组成;B组由从无创正压通气过渡到有创机械通气(失败-无创正压通气)的患者组成;C组由立即需要有创机械通气(没有事先无创正压通气)的患者组成.
结果：回顾了117例慢性阻塞性肺疾病急性加重患者（A组=96；B组=13；C组=8）的通气支持候选人。在急诊科入院时，两组之间的基线疾病严重程度和生理参数没有差异。然而，B组重症监护病房入院率较高，住院时间,重症监护病房住院时间,与A组相比,C组的院内死亡率较高。与A组相比,C组的预后也较差。与成功使用无创正压通气相关的唯一独立变量是无创正压通气1小时后动脉二氧化碳压的改善及其耐受性。
结论：我们的数据在“现实生活”急诊科队列中证实，与从无创正压通气过渡到有创机械通气的患者或立即需要有创机械通气的患者相比，成功使用无创正压通气治疗慢性阻塞性肺疾病急性加重的住院死亡率和重症监护病房住院时间较低。无创正压通气耐受性和1小时无创正压通气后较高的动脉二氧化碳压降低是成功治疗的预测因素.这些结果应在前瞻性随机对照试验中得到证实。
方法：在18个月内进行回顾性队列研究，比较以下患有慢性阻塞性肺疾病加重的患者组:A组由最初选择接受无创正压通气而随后不需要有创机械通气(成功-无创正压通气)的患者组成;B组由从无创正压通气过渡到有创机械通气(失败-无创正压通气)的患者组成;C组由立即需要有创机械通气(没有事先无创正压通气)的患者组成.
结果：回顾了117例慢性阻塞性肺疾病急性加重患者（A组=96；B组=13；C组=8）的通气支持候选人。在急诊科入院时，两组之间的基线疾病严重程度和生理参数没有差异。然而，B组重症监护病房入院率较高，住院时间,重症监护病房住院时间,与A组相比,C组的院内死亡率较高。与A组相比,C组的预后也较差。与成功使用无创正压通气相关的唯一独立变量是无创正压通气1小时后动脉二氧化碳压的改善及其耐受性。
结论：我们的数据在“现实生活”急诊科队列中证实，与从无创正压通气过渡到有创机械通气的患者或立即需要有创机械通气的患者相比，成功使用无创正压通气治疗慢性阻塞性肺疾病急性加重的住院死亡率和重症监护病房住院时间较低。无创正压通气耐受性和1小时无创正压通气后较高的动脉二氧化碳压降低是成功治疗的预测因素.这些结果应在前瞻性随机对照试验中得到证实。
