Noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and severe hypercapnic neurological deterioration in the emergency room

Abstract

We consider that severe neurological dysfunction and pH of less than 7.25 do not constitute absolute contraindications to the use of NIMV. This kind of management can be implemented in the emergency room with favorable results.

Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy

“…However, under certain circumstances, especially those produced by hypercapnic conditions [6-8], traditional NIV has produced very favorable results, even in patients with hypercapnic coma [9]. …”

“…Previous studies that recommend the use of NIV in patients with altered consciousness report a rapid recovery as soon as the ventilatory strategy is established, and most recommend early intubation and suspension of treatment if consciousness does not quickly normalize [9,10]. Altered levels of consciousness can be assessed using the Glasgow Coma Scale (GCS) [14,15], the encephalopathy scoring [16], and the Kelly-Matthay Scale (KMS) [17].…”

Il percorso diagnostico-assistenziale della broncopneumopatia cronica ostruttiva riacutizzata in Medicina Interna

“…La ventilazione non invasiva (NIV) rappresenta un efficace trattamento per la riacutizzazione severa di BPCO in pazienti con acidosi respiratoria, utilizzabile sia in Terapia Intensiva sia nelle Unità di Cure Intermedie. Evidenze recenti dimostrano come la NIV possa essere impiegata con successo in pazienti con pH > 7,3 anche in reparti di Medicina Interna se il personale è preparato; in tali pazienti sembra ridurre sia la necessità di intubazione sia la mortalità intraospedaliera [66,67].…”

Outcome of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards: Is It Really Scarce Monitoring?

“…I believe that, with early identification, there is a select group of patients who may benefit from the use of NIV outside the ICU, but they must be evaluated with predictors of success 7,8 and must also be willing to undergo NIV outside the ICU when there is a limited availability of beds in the ICU/ respiratory care unit.…”