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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2004

01-07-2004 | Original

Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance

Authors: Enzo Squadrone, Pamela Frigerio, Claudio Fogliati, Cesare Gregoretti, Giorgio Conti, Massimo Antonelli, Roberta Costa, Paola Baiardi, Paolo Navalesi

Published in: Intensive Care Medicine | Issue 7/2004

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Abstract

Objective

To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation.

Design and setting

Matched case-control study conducted in ICU.

Patients and intervention

NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV1, Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation.

Methods and results

NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications (P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days (P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay.

Conclusions

In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.
Literature
1.
Bott J, Carrol MP, Conway JH, Keity SEJ, Ward EM, Brown AM, Paul EA, Elliot MW, Godfrey RC, Wedzicha JA, Moxham J (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557
2.
Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS (1995) Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151:1799–1806
3.
Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A (1995) Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 333:817–822
4.
Celikel T, Sungur M, Cayhan B, Karakurt S (1998) Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 114:1636–1642
5.
Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri GU (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomised evaluation of non-invasive ventilation. Am J Respir Crit Care Med 160:1585–1591
6.
Plant PK, Owen JL, Elliot MW (2000) Early use of non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 335:1931–1935
7.
Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241
8.
Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, Kreit JW, Sciurba FC, Stiller RA, Sanders MH (2000) A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 161:807–813
9.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487
10.
Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F (1998) Noninvasive mechanical ventilation in the weaning of patients with acute respiratory failure due to chronic obstructive pulmonary disease: a randomized controlled trial. Ann Intern Med 128:721–728
11.
Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G (1999) Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med 160:86–92
12.
Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, Gasparetto A, Meduri GU (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435
13.
Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU (2002) Noninvasive vs conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 28:1701–1707
14.
Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A (2000) Noninvasive positive pressure ventilation in the setting of severe, acute exacerbation of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med 28:2094–2102
15.
Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577
16.
International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societé de Reanimation de Langue Francaise, and approved by the ATS Board of Directors (2001). Intensive Care Med 27:166–178
17.
Carlucci A, Richard JC, Wysocky M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiology survey. Am J Respir Crit Care Med 63:874–880
18.
Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
19.
Nevins ML, Epstein SK (2001) Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 119:1840–1849
20.
Wood KA, Lewis L, Von Harz B, Kollef MH (1998) The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest 113:1339–1346
21.
Meduri GU, Fox RC, Abou-Shala N, Leeper KV, Wunderink RG (1994) Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. Crit Care Med 22:1584–1590
22.
Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E (1996) Noninvasive positive pressure ventilation via face mask: first line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109:179–193
23.
Elliott MW (2002) Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new gold standard? Intensive Care Med 28:1691–1694
24.
Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Med 25:662–667
25.
Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
26.
Goris RJ, te Boekhorst TP, Nuytinck JK, Gimbrere JS (1985) Multiple organ failure. Arch Surg 120:1109–1115
27.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655
28.
Breslow NE, Day NE (1980) The analysis of case-control studies. In: International Agency for Research on Cancer (ed) Statistical methods in cancer research, vol. 1. IARC, Lyon
29.
Sacks H, Chalmers TC, Smith H Jr (1982) Randomized versus historical controls for clinical trials. Am J Med 72:233–240
30.
Benson K, Hartz AJ (2000) A comparison of observational studies and randomized controlled trials. N Engl J Med 342:1878–1886
31.
Concato J, Shah N, Horwitz RI (2000) Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 342:1887–1892
32.
Ambrosino N, Foglio K, Rubini F, Clini E, Nava S, Vitacca M (1995) Noninvasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 50:755–757
33.
Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L (2000) Association of non-invasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 284:2361–2367
34.
Nourdine K, Combes P, Carton MJ, Beuret P, Cannamela C, Ducreux JC (1999) Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med 25:567–573
Metadata
Title
Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance
Authors
Enzo Squadrone
Pamela Frigerio
Claudio Fogliati
Cesare Gregoretti
Giorgio Conti
Massimo Antonelli
Roberta Costa
Paola Baiardi
Paolo Navalesi
Publication date
01-07-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2320-7

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