Prediccion de fracaso en ventilacion mecanica no invasiva en falla respiratoria en enfermedad pulmonar obstructiva cronica a grandes alturas
Artículo académico
Visión General
Visión General
Abstracto
Management with non-invasive mechanical ventilation (NIMV) in exacerbations of chronic obstructive pulmonary disease (COPD) reduces the need for intubation and the associated complications. It is therefore indicated in clinical settings of acute respiratory failure. The gasometric variables described at sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level). The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy) and to describe the variables at admission associated with failure in patients with exacerbation of COPD and respiratory failure that require management in the intensive care unit (ICU).
Management with non-invasive mechanical ventilation (NIMV) in exacerbations of chronic obstructivepulmonary disease (COPD) reduces the need for intubation and the associated complications. It istherefore indicated in clinical settings of acute respiratory failure. The gasometric variables describedat sea level are not applicable at the altitude of Bogotá, Colombia (2.640 meters above sea level).The objective was to quantify the frequency of failure of NIMV (defined as death, intubation, or tracheostomy)and to describe the variables at admission associated with failure in patients with exacerbationof COPD and respiratory failure that require management in the intensive care unit (ICU).METHODS: a retrospective cohort was analyzed; clinical characteristics, severity scores, and gasometricvalues were registered. The differences between the success and failure groups were evaluated.A logistic regression analysis was applied to explore factors associated with outcome.RESULTS: 158 patients were included; 54,5% were women; the mean age was 74,3±8,8 years.Characteristics at admission: APACHE 17,1±4,1, PaCO2 52,7±14,9 mm Hg, PaO2/FIO2 166,6±61,1,pH 7,32±0,09, FC 104,4±23,1. Management with BiPAP: 93%, CPAP: 7%. NIMV failed in 24,1%(orotracheal intubation: 15,8%, tracheostomy: 6,3%, and mortality: 12%). On multivariate analysis,the variables associated with failure were: APACHE ≥17 (OR: 2,34 [1,04-5,3]) and PaCO2≥55 (OR:2,47 [1,08-5,79]). There was no association with sex or PaO2/FIO2.CONCLUSIONS: the percentage of failure with NIMV (24,1%) was less than that reported in the internationalliterature. The risk factors found (high APACHE and PaCO2) are confirmed as predictors offailure in NIMV, and are applicable to Bogotá or similar altitudes. High altitudes do not appear to haveinfluence on the outcomes of patients with COPD exacerbations that require management in an ICU.
