Noninvasive ventilation weaning in acute hypercapnic respiratory failure due to COPD exacerbation : A real-life observational study
Faverio, Paola (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Stainer, A. (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
De Giacomi, Federica (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Messinesi, Grazia (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Paolini, Valentina (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Monzani, Anna (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Sioli, Paolo (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Memaj, I. (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Sibila, Oriol (Institut d'Investigació Biomèdica Sant Pau)
Mazzola, P. (Ospedale San Gerardo (Itàlia))
Pesci, Alberto (School of Medicine and Surgery. University of Milan Bicocca. Respiratory Unit. San Gerardo Hospital. ASST Monza)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	The most recent British Thoracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering. However, a limited number of studies evaluated the phase of NIV weaning. The aim of this study is to describe the NIV weaning protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients' characteristics, clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group). Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described, our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Canadian Respiratory Journal, Vol. 2019 (2019) , p. 3478968, ISSN 1916-7245

DOI: 10.1155/2019/3478968
PMID: 31019611

10 p, 1.1 MB

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