The application of improved Glasgow coma scale score of 15 as switching point for invasive-noninvasive mechanical ventilation in treatment of severe respiratory failure in chronic obstructive pulmonary disease

ArticleinZhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 23(4):224-7 · April 2011
DOI: 10.3760/cma.j.issn.1003-0603.2011.04.012 · Source: PubMed
To estimate the feasibility and the efficacy of early extubation and the sequential non invasive mechanical ventilation (MV) in severe respiratory failure of chronic obstructive pulmonary disease (COPD) with the improved Glasgow coma scale (GCS) score of 15 as the switching point. By a prospective control study, 20 patients with COPD and respiratory failure who had undergone endotracheal intubation and MV from March 2007 to November 2009 were enrolled as treatment group. Invasive MV with synchronous intermittent mandatory ventilation and pressure support ventilation (SIMV+PSV) pattern were given to these patients. When the period of "improved GCS score of 15 standard" window period appeared and being kept for 2 hours, endotracheal tube was extubated, and nasal mask with PSV+positive end expiratory pressure (PEEP) was used, followed by gradual decrease of the level of pressure support till weaning of MV. Nineteen patients who were treated with MV with ordinary way of weaning from March 2005 to March 2007 served as the control group. Prior to the MV, the ventilation and oxygenation index , the length of invasive MV, total MV time, total hospital stay, re intubation and ventilator associated pneumonia (VAP) occurred in the number of cases were observed and compared between two groups. There was no significant difference in the ventilation and oxygenation index prior to the MV. Compared with control group, in treatment group, the length of invasive ventilation (days: 3.2±1.1 vs. 10.5±3.2), the total duration of MV (days: 4.8±2.5 vs. 10.5±3.2), the length of hospital stay (days: 17±3 vs. 22±7) were significantly shorter (all P<0.01), and the incidence of VAP was significantly lower (cases: 0 vs. 5, P<0.01), while the number of re intubation was slightly higher but without statistical significance (cases: 3 vs. 1, P>0.05). The application of improved GCS score of 15 as the switching point with 2 hours as window period for early extubation and non invasive nasal mask ventilation can significantly improve the therapeutic effect in patients with severe respiratory failure in COPD.
  • [Show abstract] [Hide abstract] ABSTRACT: Noninvasive positive pressure ventilation (NIPPV) has been proposed to shorten the duration of mechanical ventilation in intubated patients, especially those who fail initial weaning from invasive mechanical ventilation (IMV). However, there are also some discrepancies in terms of weaning success or failure, incidence of re-intubation, complications observed during study and patient outcomes. The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure, by comparing with conventional invasive weaning approach. We searched randomized controlled trials (RCTs) comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge and Springerlink databases. Records from conference proceedings and reference lists of relevant studies were also identified. A total of 11 RCTs with 623 patients were available for the present analysis. Compared with IMV, NIPPV significantly increased weaning success rates (odds ratio (OR): 2.50, 95% confidence interval (CI): 1.46 - 4.30, P = 0.0009), decreased mortality (OR: 0.39, 95%CI: 0.20 - 0.75, P = 0.005), and reduced the incidence of ventilator associated pneumonia (VAP) (OR: 0.17, 95%CI: 0.08 - 0.37, P < 0.00001) and complications (OR: 0.22, 95%CI: 0.07 - 0.72, P = 0.01). However, effect of NIPPV on re-intubation did not reach statistical difference (OR: 0.61, 95%CI: 0.33 - 1.11, P = 0.11). Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates, decreasing the risk of mortality and reducing the incidence of VAP and complications, in patients who need weaning from IMV. However, it should be applied with caution, as there is in.
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  • [Show abstract] [Hide abstract] ABSTRACT: Objective: Noninvasive mechanical ventilation (NIMV) is quite useful for weaning and shortening the duration of invasive mechanical ventilation (IMV) in patients with acute respiratory failure (ARF). In this study, we aimed to determine the positive and negative consequences of using NIMV during weaning in patients who were receiving IMV because of ARF. Material and Methods: Our study was conducted between January 2012 and 2014 in the Emergency Medicine Department of the Konya Training and Research Hospital. Patients who were ≥18 years old and who were followed up in the emergency critical care unit with IMV due to ARF and performed NIMV for weaning were included in the study. Our study was a retroprospective study, which was conducted by analyzing patient files. Results: A total of 52 patients were included in the study. The number of patients in whom weaning was successful were 32 (61.5%), and the number of patients who failed weaning was 20 (38.5%). All the patients with initial successful weaning were discharged from the hospital, and all the patients who failed weaning died (p=0.000). The lactate level in arterial blood gas was 1.5 mmol/L [inter-quartile range (IQR): 0.7] in the successful group, and it was 2.4 mmol/L (IQR: 1.5) in the failed group. The lactate values were significantly higher in the failed group (p=0.011). We also performed receiver operating characteristic (ROC) analysis to determine the effects of lactate levels on successful weaning. This analysis showed that the cut-off value of lactate was 2.1 mmol/L [ROC curve: area under the curve 0.712, 95% confidence interval (Cl): 0.553–0.870; p=0.011]. Conclusion: Using NIMV for the ventilator separation process has become more popular in recent years. In addition, it is a more successful method than conventional methods. Arterial blood gases and lactate levels during weaning are elevated in patients who performed failed weaning. © 2015 by Turkish Society of Medical and Surgical Intensive Care Medicine.
    Full-text · Article · Nov 2015 · Chinese medical journal