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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2009

01-04-2009 | Original

Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study

Authors: Andrea Purro, Lorenzo Appendini, Carolina Polillo, Giovanni Musso, Claudio Taliano, Fabio Mecca, Roberto Colombo, Giorgio Carbone

Published in: Intensive Care Medicine | Issue 4/2009

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Abstract

Objective

The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD.

Design

Prospective study.

Setting

Division of Emergency Critical Care and Chronic Ventilator Unit.

Patients

A total of 24 COPD patients: nine patients requiring ventilatory support because of acute respiratory acidosis due to COPD exacerbation (NPPV group, pH 7.28 ± 0.02); seven patients successfully managed with medical therapy only (SB group, pH 7.39 ± 0.04); eight clinically stable, long term mechanically ventilated, COPD patients (IPPV group).

Measurements

Respiratory mechanics during a period of unsupported breathing.

Results

A rapid shallow breathing, in the presence of a high drive to breath and a high diaphragmatic tension-time index (TTdi), was found in NPPV and IPPV groups compared to the SB group (f/V T ratio: 118 ± 43 and 137 ± 65, respectively, versus 37 ± 12 breaths/min/L; P 0.1: 5.0 ± 1.0 and 5.4 ± 1.4, respectively, versus 2.2 ± 0.2 cmH2O, TTdi: 0.168 ± 0.035 and 0.161 ± 0.039, respectively, versus 0.057 ± 0.033); at variance, PEEPidyn was greater in IPPV compared to the other two groups. A significant relationship was observed between TTdi ratio and f/V T (Rho 0.756).

Conclusion

During the early phases of an acute exacerbation, patients with COPD and acute respiratory failure had an imbalance between the decreased capacity of the respiratory muscles to generate pressure and the increased respiratory load. This imbalance was similar to that recorded in patients with COPD and chronic ventilatory failure. In both groups, the imbalance was associated with rapid shallow breathing. Among the mechanical constraints to ventilation, only PEEPi,dyn was different between acute and chronic patients with ventilatory failure.
Appendix
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Metadata
Title
Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study
Authors
Andrea Purro
Lorenzo Appendini
Carolina Polillo
Giovanni Musso
Claudio Taliano
Fabio Mecca
Roberto Colombo
Giorgio Carbone
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1353-8

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