2001 OPEN FORUM Abstracts
BI-LEVEL POSITIVEAIRWAY PRESSURE (PAP) IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITHA PRIMARY DIAGNOSIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE.
Rebecca L. Meredith,BS, RRT. The Cleveland Clinic Foundation, Cleveland, Ohio.
Background: The use of noninvasiveventilatory support has gained popularity over the last decade. The techniquehas been shown to decrease work of breathing and increase the functional residualcapacity of patients in acute respiratory distress of cardiac, pulmonary, orneurologic origin. This study addresses the use of Bi-level PAP in EmergencyDepartment (ED) patients presenting with a primary diagnosis of Chronic ObstructivePulmonary Disease (COPD) resulting in acidosis and hypercapnia. The aim is toevaluate the impact of Bi-level PAP on arterial blood gases, oxygen requirements,hospital admission to a regular nursing floor (RNF) vs an intensive care unit(ICU), and avoidance of intubation.
Method: The sample was comprisedof 17 patients presenting to the ED with a primary diagnosis of COPD. Separatedata collection sheets were utilized for all patients placed on the Bi-levelPAP system. Patients were assessed and rated on their intensity of sensationusing a modified Borg Dyspnea Category Scale with 0 being nothing at all and10 being maximal. The patients were managed by the physician and respiratorytherapist in the ED with Bi-level PAP settings adjusted to patient tolerance.Inspiratory Positive Airway Pressure/Expiratory Positive Airway Pressure (IPAP/EPAP)were set for patient comfort, ABG/saturation, and control of ventilation. Averageswere 14/7 respectively. All patients were in the spontaneous/timed (S/T) mode.Breaths/minute were set two to five below the patient\?92s spontaneous rate(average 25). All patients had continuous ECG and pulse oximetry monitoring.
Results: Table 1 presentsarterial blood gas (ABG) mean with ranges in parenthesis and dyspnea index.Patients\?92 oxygen requirements before Bi-level PAP averaged 40% which increasedto 44% after initiation of treatment. Intubation was not required in any ofthe 17 patients. Four (24%) were admitted to an ICU; thirteen (76%) went toa RNF and were successfully managed with Bi-level PAP.
Conclusion: Bi-level PAP decreasedthe work of breathing and improved the ventilation of patients presenting tothe ED with a primary diagnosis of COPD. Additionally, intubation was not requiredin any of the patients thus avoiding complications such as airway trauma, nosocomialinfection, and death.
Table 1: ABG / Dyspnea Index
|Before (n=17)||After (n=17)}|
|pH: 7.20(7.11-7.29)||pH: 7.31(7.24-7.38)}|
|PaCO2: 95(55-156)||PaCO2: 72(37 - 106)}|
|PaO2: 77 (47-100)||PaO2: 67 (53 -86)}|
|HCO3 : 38(27-57)||HCO3 : 37(25-62) }|
|% Sat: .90(.76-.99)||% Sat: .89(.82-.96)}|
|Dyspnea index:7||Dyspnea index:3|