Intensive Care Medicine

, Volume 33, Issue 12, pp 2101–2108 | Cite as

Noninvasive versus conventional ventilation to treat hypercapnic encephalopathy in chronic obstructive pulmonary disease

  • Raffaele Scala
  • Stefano Nava
  • Giorgio Conti
  • Massimo Antonelli
  • Mario Naldi
  • Ivano Archinucci
  • Giovanni Coniglio
  • Nicholas S. Hill
Original

Abstract

Objective

We recently reported a high success rate using noninvasive positive pressure ventilation (NPPV) to treat COPD exacerbations with hypercapnic encephalopathy. This study compared the hospital outcomes of NPPV vs. conventional mechanical ventilation (CMV) in COPD exacerbations with moderate to severe hypercapnic encephalopathy, defined by a Kelly score of 3 or higher.

Design and setting

A 3-year prospective matched case-control study in a respiratory semi-intensive care unit (RSICU) and intensive care unit (ICU).

Patients and participants

From 103 consecutive patients the study included 20 undergoing NPPV and 20 CMV, matched for age, simplified acute physiology score II, and baseline arterial blood gases.

Measurements and results

ABG significantly improved in both groups after 2 h. The rate of complications was lower in the NPPV group than in the CMV group due to fewer cases of nosocomial pneumonia and sepsis. In-hospital mortality, 1-year mortality, and tracheostomy rates were similar in the two groups. Fewer patients remained on ventilation after 30 days in NPPV group. The NPPV group showed a shorter duration of ventilation.

Conclusions

In COPD exacerbations with moderate to severe hypercapnic encephalopathy, the use of NPPV performed by an experienced team compared to CMV leads to similar short and long-term survivals with a reduced nosocomial infection rate and duration of ventilation.

Keywords

Acute respiratory failure Chronic obstructive pulmonary disease Conventional ventilation Endotracheal intubation Hypercapnic encephalopathy Noninvasive ventilation 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Raffaele Scala
    • 1
  • Stefano Nava
    • 2
  • Giorgio Conti
    • 3
  • Massimo Antonelli
    • 3
  • Mario Naldi
    • 1
  • Ivano Archinucci
    • 1
  • Giovanni Coniglio
    • 1
  • Nicholas S. Hill
    • 4
  1. 1.Unità Operativa di Pneumologia e Unità di Terapia Semi-Intensiva RespiratoriaArezzoItaly
  2. 2.Respiratory Intensive Care UnitFondazione S. MaugeriPaviaItaly
  3. 3.Intensive Care Unit and AnesthesiologyUniversità CattolicaRomeItaly
  4. 4.Division of Pulmonary, Critical Care and Sleep MedicineTufts-New England Medical CenterBoston,USA

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