Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new gold standard?

Elliott, Mark

doi:10.1007/s00134-002-1503-3

Cited by 36 publications

(4 citation statements)

References 38 publications

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“…2004). Several authors have suggested NIV should be the first‐line treatment for management of acute COPD exacerbation (Brochard 2000, Elliott 2002, Hill 2003). International guidelines recommend NIV should be initiated in the ED, if staff have been adequately trained (Evans 2001).…”

Section: Resultsmentioning

confidence: 99%

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

Rose¹,

Gerdtz²

2009

Journal of Clinical Nursing

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Monitoring of non-invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask-fit and high air flows; serious complications are few and occur infrequently. The use of non-invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department.

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Section: Resultsmentioning

confidence: 99%

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

Rose¹,

Gerdtz²

2009

Journal of Clinical Nursing

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“…24 Yet, the overall hospital mortality rate of 3.9% in our study was lower than other "real-life studies" such as a large UK study of 233 hospitals (26%) and a study of NIV administration in the ward (32%). 3,6 As for failure rate, the literature quoted 15-28% for patients with mild to moderate respiratory acidosis (pH 7.25-7.35) 1,25 but the rate increased to 62% in severe acidosis (pH <7.25). 26,27 Our study demonstrated a lower failure rate in both phases with a comparable pH to the studies m e n t i o n e d , w h i c h f u r t h e r d e c r e a s e d p o s timplementation.…”

Section: Discussionmentioning

confidence: 99%

From ICU to Emergency Department: 9-Year Experience with Non-Invasive Ventilation for COPD

Ibrahim

Phua²,

Goh

et al. 2014

Hong Kong Journal of Emergency Medicine

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Non-invasive ventilation (NIV) has been shown to be beneficial for chronic obstructive pulmonary disease (COPD) patients with persistent respiratory acidosis during acute exacerbations. This clinical study described the experience of implementing an NIV program in the emergency department for COPD patients. Methods: In the pre-implementation phase, patients who presented to the emergency department were transferred to the intensive care unit for NIV. Following the NIV program, patients had NIV commenced in the emergency department. We reported the change in hospital outcomes pre and postimplementation. Results: A total of 153 patients received NIV, 34 in the pre-implementation phase and 119 patients in the post-implementation phase. The mean pH was 7.220.07 and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18.94. Hospital mortality was lower in the post-implementation phase (1.7% versus 11.8%; p=0.008). The median door-to-NIV time was shorter in the post-implementation phase (64 minutes; interquartile range [IQR] 35-113) versus (457 minutes; IQR 143-1320). Conclusions: NIV program in the emergency department is feasible and is associated with better hospital outcomes in patients with COPD. (Hong Kong j.emerg.med. 2014;21:140-147) 簡介：無創通氣(NIV)，已被證明對慢性阻塞性肺疾病(COP D)急性發作持續性呼吸性酸中毒患者是有益的。本臨床研究旨在描述，在急診科為 COPD 患者實施 NIV 方案的經驗。方法：在實施前的階段，急診病人被轉入深切治療部施行 NIV 。 NIV 方案實施後，在急診室開始為患者施行 NIV 。我們報告 NIV 方案實施前和後病人在醫院治療結果的變化。結果：共有 153 例患者接受 NIV ， 34 在 NIV 方案實施前， 119 名患者在實施後階段。平均 pH 值為 7.22  0.07 ， APACHE Ⅱ評分為 18.9  4 。實施後階段住院死亡率明顯較低(1.7% 對 11.8% ， p=0.008)。從到診到 NIV 所需時間中位數在實施後階段較短(64 分鐘；四分位數範圍 [IQR]35-113)與(457 分鐘； IQR143-1320)。結論：在急診科實施 NIV 方案是可行的，並與 COPD 患者更好的治療結果有關。

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“…Moreover, the same type of treatment, mechanical ventilation and respirator weaning procedure were applied to all patients in this monocenter study. Most of the patients (80%) had been treated by NIV before intubation as currently recommended [9]. The intubation for MV was based on definite clinical and blood gas criteria which were correlated with a high rate of NIV failure (respiratory frequency >35/mn, pH < 7.25 at admission [10], coma [11]).…”

Section: Discussionmentioning

confidence: 99%

Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study

et al. 2012

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BackgroundMechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF) in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL) score may help to predict the outcome of these patients.MethodsWe studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68%) or failure (group B n = 8, 32%). We investigated the correlation between the ADL score and the outcome and mortality.ResultsThe ADL score was higher in group A (5.1 ±1.1 vs 3.7 ± 0.7 in group B, p < 0.01). Weaning was achieved in 76.5% of the cases with an ADL score ≥ 4 and in 23.5% of the cases with an ADL score < 4 (p < 0.05). Pulmonary function test, arterial blood gases collected during period of clinical stability and at admission and nutritional status were similar in both groups. The mortality, at six months, was 36%. The ADL score was a significant predictor of 6-month mortality (80 with an ADL score <4, 20 with an ADL score ≥4, p < 0.01).ConclusionOur pilot study demonstrates that the ADL score is predictive of weaning success and mortality at 6 months, suggesting that the assessment of daily activities should be an important component of ARF management in COPD patients.

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Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new gold standard?

Cited by 36 publications

References 38 publications

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

From ICU to Emergency Department: 9-Year Experience with Non-Invasive Ventilation for COPD

Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study

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