Intensive Care Medicine

, Volume 22, Issue 2, pp 94–100 | Cite as

Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short-and long-term prognosis

  • M. Vitacca
  • E. Clini
  • F. Rubini
  • S. Nava
  • K. Foglio
  • N. Ambrosino
Original

Abstract

Objective

To evaluate the short-and long-term prognosis of patients with chronic obstructive lung disease (COLD) who had noninvasive mechanical ventilation (NMV) for acute respiratory failure (ARF).

Design

Retrospective study.

Setting

Two respiratory intermediate intensive care units.

Patients

Two groups of patients suffering from COLD and an ARF episode requiring mechanical ventilation. Group 1 (30 patients) was given NMV using face masks (aged 64±9 years; pH=7.28±0.05; PaCO2=83±18 mmHg; PaO2/FIO2=141±61). Group 2 (27 patients) was composed of control patients (aged=65±8 years; pH=7.26±0.05; PaCO2=75±17 mmHg; PaO2/FIO2=167±41) given MV using endotracheal intubation (EI) when clinical and functional conditions had further deteriorated because the medical therapy failed and NMV was not available at the time. Causes of ARF were in group 1 and 2 respectively: pneumonia in 8(27%) and 11(41%), acute exacerbation of COLD in 19 (63%) and 14 (52%) and pulmonary embolism in 3 (10%) and 2 (7%) patients.

Measurements and results

Success rate, mortality during stay in ICU (at 3 months and at 1 year), and the need for rehospitalization during the year following ARF were measured in this study. Group 1 showed a success rate of 74%, only 8/30 patients needing EI and conventional MV. In group 2, the weaning success was 74% (20/27 patients). The mortality for group 1 was 20% in IICU, 23% at 3 months and 30% at 1 year; and 26% for group 2 in ICU, 48% at 3 months and 63% at 1 year. Within each group 1-year mortality was greater (p<0.01) in patients with pneumonia. The number of new ICU admissions during the follow-up at 1 year was 0.12 versus 0.30 in groups 1 and 2 respectivelyp<0.05).

Conclusion

For patients suffering from COLD who have undergone ARF, avoiding EI by early treatment with NMV is associated with better survival in comparison to patients bound to invasive MV. Pneumonia as a cause of ARF may worsen the prognosis in both groups of patients.

Key words

COPD Mask ventilation Pneumonia Endotracheal intubation Intermediate intensive care unit Positive pressure ventilation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Derenne JP, Fleury B, Pariente R (1988) Acute respiratory failure of chronic obstructive pulmonary disease. Am Rev Respir Dis 138: 1006–1033Google Scholar
  2. 2.
    Gracey DR, Naessens JM, Krishan I, Marsh HM (1992) Hospital and post hospital survival in patients mechanically ventilated for more than 29 days. Chest 101: 211–214Google Scholar
  3. 3.
    Stauffer JL, Fayter N, Graves B, Cromb M, Lynch JC, Goebel P (1993) Survival following mechanical ventilation for acute respiratory failure in adult men. Chest 104: 1222–1229Google Scholar
  4. 4.
    Swinburne AJ, Fedullo AJ, Bixby K, Lee DK, Wahl GW (1993) Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation. Arch Intern Med 153: 1657–1662Google Scholar
  5. 5.
    Rieves RD, Bass D, Carter RR, Griffith JE, Norman JR (1993) Severe COPD and acute respiratory failure. Correlates for survival at the time of tracheal intubation. Chest 104: 854–860Google Scholar
  6. 6.
    Rello J, Ausina V, Ricart M, Castella J, Prats G (1993) Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 104: 1230–1235Google Scholar
  7. 7.
    Menzies R, Gibbons W, Goldberg P (1989) Determinants of weaning and survival among patients with COLD who require MV for acute respiratory failure. Chest 95: 398–405Google Scholar
  8. 8.
    Warren PM, Flenley DC, Millar JS, Avery A (1980) Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961–1968 and 1970–1976. Lancet I: 467–471Google Scholar
  9. 9.
    Gillepsie DJ, Marsh HMM, Divertie MB, Meadows JA (1986) Clinical outcome of respiratory failure in patients requiring prolonged (>24 hours) mechanical ventilation. Chest 90: 364–369Google Scholar
  10. 10.
    Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR (1986) Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 133: 792–796Google Scholar
  11. 11.
    Sluiter HJ, Blokzijil EJ, Vandijl W et al (1972) Conservative and respirator treatment of acute respiratory insuficiency in patients with chronic obstructive lung disease. A reappraisal. Am Rev Respir Dis 105: 932–943Google Scholar
  12. 12.
    Hudson LD (1989) Survival data in patients with acute and chronic lung disease requiring mechanical ventilation. Am Rev Respir Dis 140: S19-S24Google Scholar
  13. 13.
    Nunn JF, Milledge JS, Singaraya J (1979) Survival of patients ventilated in an intensive therapy unit. BMJ 1: 1525–1527Google Scholar
  14. 14.
    Spicher JE, White DP (1987) Outcome and function following prolonged mechanical ventilation. Arch Intern Med 147: 421–425Google Scholar
  15. 15.
    Kaelin RM, Assimacopoulos A, Chevrolet JC (1987) Failure to predict six-month survival of patients with COPD requiring mechanical ventilation by analysis of simple indices. A prospective study. Chest 92: 971–978Google Scholar
  16. 16.
    Potgieter PD, Rosenthal E, Benatar SR (1985) Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med 13: 798–802Google Scholar
  17. 17.
    Petheram IS, Branthwaite MA (1980) Mechanical ventilation for pulmonary disease. A six year survey. Anaesthesia 35: 467–473Google Scholar
  18. 18.
    Sukulmachantra Y, Dinakara P, Williams MH (1966) Prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute ventilatory failure: a 3-year follow-up study. Am Rev Respir Dis 93: 215–222Google Scholar
  19. 19.
    Torres A, Aznar R, Gatell JM et al (1990) Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142: 523–528Google Scholar
  20. 20.
    Pingleton S (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137: 1463–1493Google Scholar
  21. 21.
    Brochard L, Isabey D, Piquet J et al (1990) Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 323: 1523–1530Google Scholar
  22. 22.
    Meduri GU, Abou-Shala N, Fox RC et al (1991) Non invasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100: 445–454Google Scholar
  23. 23.
    Fernandez R, Blanch L, Valles J, Baigorri F, Artigas A (1993) Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COLD patients. Intensive Care Med 19: 456–461Google Scholar
  24. 24.
    Vitacca M, Rubini F, Foglio K, Scalvini S, Nava S, Ambrosino N (1993) Noninvasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients. Intensive Care Med 19: 450–455Google Scholar
  25. 25.
    Ambrosino N, Nava S, Rubini F (1993) Non invasive mechanical ventilation in the treatment of acute respiratory failure in chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 48: 144–154Google Scholar
  26. 26.
    Corrado A, Bruscoli G, Messori A et al (1992) Iron lung treatment of subjects with COPD in acute respiratory failure. Evaluation of short and long term prognosis. Chest 101: 692–696Google Scholar
  27. 27.
    Tobin MJ (1994) Mechanical ventilation. N Engl J Med 330: 1056–1061Google Scholar
  28. 28.
    American Thoracic Society (1987) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 136: 225–243Google Scholar
  29. 29.
    Teasdale G (1974) Assessment of coma and impaired consciousness: a practical scale. LancetT: 81–83Google Scholar
  30. 30.
    NHLBI Workshop Summary (1990) Respiratory muscle fatigue: report of the respiratory muclle fatigue workshop group. Am Rev Respir Dis 142: 474–480Google Scholar
  31. 31.
    Jeffrey AA, Warren PM, Flenley DC (1992) Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management. Thorax 47: 34–40Google Scholar
  32. 32.
    Quanjer PH (1983) Working party on “standardization of lung function test”. Bull Eur Physiopathol Respir 19 [Suppl 5]: 7–10Google Scholar
  33. 33.
    Benhamou D, Girault C, Faure C, Portier F, Muir JF (1922) Nasal mask ventilation in acute respiratory failure. Experience in elderly patients. Chest 102: 912–917Google Scholar
  34. 34.
    Bott J, Carroll MP, Conway JH et al (1993) Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341: 1555–1557Google Scholar
  35. 35.
    Nava S, Rubini F, Zanotti E et al (1994) Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days. Eur Respir J 7: 1645–1652Google Scholar
  36. 36.
    Bone RC (1981) Acute respiratory failure and chronic obstructive lung disease: recent advances. Med Clin North Am 65: 563–578Google Scholar
  37. 37.
    Centers for Disease Control (1986) Nosocomial infection surveillance, 1984. In surveillance summaries. 35: 17–29Google Scholar
  38. 38.
    Gross PA (1987) Epidemiology of hospital-acquired pneumonia. Semin Respir Infect 2: 2–7Google Scholar
  39. 39.
    Stevens RM, Teres D, Skilman JJ, Feingold DS (1974) Pneumonia in an intensive care unit. Arch Intern Med 134: 106–111Google Scholar
  40. 40.
    Potgieter PD, Hammond JMJ (1992) Etiology and diagnosis of pneumonia requiring MICU admission. Chest 101: 199–203Google Scholar
  41. 41.
    Fagon JY, Chastre J, Hance A, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94: 281–287Google Scholar
  42. 42.
    Brochard L (1993) Non invasive ventilation: practical issues. Intensive Care Med 19: 431–432Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • M. Vitacca
    • 1
    • 2
  • E. Clini
    • 2
  • F. Rubini
    • 3
  • S. Nava
    • 3
  • K. Foglio
    • 2
  • N. Ambrosino
    • 2
  1. 1.Centro Medico di Riabilitazione di GussagoGussago (Brescia)Italy
  2. 2.Clinical del Lavoro Foundation IRCCS, Department of Pulmonary RehabilitationMedical Center of GussagoItaly
  3. 3.Clinica del Lavoro Foundation IRCCS, Department of Pulmonary RehabilitationMedical Center of MontescanoItaly

Personalised recommendations