Noninvasive Ventilation In Chronic Obstructive Pulmonary Disease With Severe Respiratoy Failure And Do-Not-Intubate Orders

Objective:Respiratory diseases are common in clinic, and chronic obstructive pulmonary disease (COPD) are the common disease in Respiratory. The aim of this study is to explore the clinical efficacy and the predictive failure factors of invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with severe respiratory failure and do-not-intubate (DNI) orders.Methods:Analysed the clinical data of50patients with AECOPD with SRF and DNI orders who received the NIV from January2006through December2010. All patients got routine therapy and NIV. They would be divided into successful group and failure group based on the treatment effects on the seventh day. Therapists initiated NIV according to the method described subsequently:They selected Bilevel positive airway pressure (BiPAP) ventilators and an mask, the ventilators were set in the S/T mode with a backup rate of12-15/min. Initial expiratory positive airway pressure (EPAP) was4cmH2O, and it could be adjusted upward to6cmH2O. Initial preassure support ventilation (PSV) was8-12cmH2O, and it could be adjusted upward to18cmH2O as tolerated by the patients and as deemed necessary by the therapist to alleviate respiratory distress. Oxygen was set at5L/min administered via a connector in the mask, with adjustments to maintain oxygen saturation90%-95%.Results:In50cases,36(72.0%) and14(28.0%) were grouped in successful group and failure group, respectively. In successful group, PaO2, Glasgow coma scale (GCS) increased significantly (P<0.05) after1-2hours NIV, though pH、 PaCO2improved after4hours-1day (P<0.01); all36patients discharged from hospital after (8.3±2.2) NIV days andhospitalized (10.8±2.4) days. In the failured group, although the blood gas analysis and GCS got partly improved after1-2hours and4hours (P<0.05), they deteriorated after1day-3days, and all needed tracheal intubation for invasive mechanical ventilation (IMV)(the tracheal intubation rate is28.0%),9patients (18.0%) died in hospital. Compared with the successful group the characters of the failure group are older age, longer course of disease, lower GCS, lower pH and PaO2. higher PaCO2and faster respiratory rate (RR), etc.Conclusion:There are some efficacy of NIV in AECOPD with SRF and DNI orders.