The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

PROSPECTIVE EVALUATION OF NONINVASIVE POSITIVE PRESSURE VENTILATION (NPPV) FOR ACUTE RESPIRATORY FAILURE(ARF) IN COPD PATIENTS(PTS).

Allen G. Kendall RRT, Peter C. Gay MD. Mayo Foundation, Rochester, MN 55905.

We have presented the results of NPPV therapy for a diverse pt population in the acute care setting using a prospective registry and standardized respiratory therapist driven protocol (Resp Care: Vol. 41, p. 945, 10/96). The COPD population is generally regarded as a more difficult group in which to achieve success with NPPV but specific and uniform criteria compromise comparisons between studies. We now report a 9 month experience with NPPV in 38 COPD pts with ARF that includes APACHE scoring data and post hospital discharge outcome. The 38 pts includes 23 males/15 females with a mean ± standard deviation age of 69.6 ± 8.8 yrs and body mass index (kg/m^{2}) of 26.6 ± 7.5. There were 20 pts who had been intubated in the past, and a "do not resuscitate status" was noted in only 8 pts. A pt triggered mode was used in all cases with a backup timed machine rate added in 47% pts. The mean inspiratory and expiratory pressure settings of the selected ventilator assist device were 11.8 ± 2.3 and 4.6 ± 0.9 cm H_{2}O respectively. A full face mask was preferred over a nasal mask by 78.9% of pts. The pts continued actual NPPV use for 23.2 ± 18 hours over 2.8 ± 2.5 days during a total hospital stay of 19.7 ± 16.9 days. There were 16 pts who were either stabilized or improved with NPPV in the hospital and 22 pts either refused to continue (11 pts) or failed the therapy and required intubation (11 pts). There were 6 pts worse or expired by the hospital discharge date but when the follow-up outcome was assessed (at 34.5 ± 30.3 days), 24 of 31 pts were stable or improved. In comparing the 23% pts with death or worse outcome vs 77% pts stable or improved at 1 mos follow-up, the APACHE II scores on admission (47.7 ± 19.6 vs 32.3 ± 19.7) were significantly different (p < 0.05). The APACHE II scores in pts who were acutely stabilized or improved were however, not significantly different between admission and discharge. We conclude that although APACHE scores were helpful in predicting final outcome after NPPV in COPD pts, the scores were not useful in tracking progress of pts who were stabilized or improved during NPPV therapy. In comparing this COPD group to our previously reported overall NPPV population, there was no significant outcome difference; i.e. 57.8% of COPD pts vs 66% overall who were introduced to NPPV for ARF were initially stabilized or improved while 28.9% vs 19.6% actually required intubation. This work was supported in part by an unrestricted grant by Respironics Inc., Murraysville, Pa.

OF-97-153

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 1997 Abstracts » PROSPECTIVE EVALUATION OF NONINVASIVE POSITIVE PRESSURE VENTILATION (NPPV) FOR ACUTE RESPIRATORY FAILURE(ARF) IN COPD PATIENTS(PTS).