2006 OPEN FORUM Abstracts
EFFECTS OF INTRAPULMONARY PERCUSSIVE VENTILATION AS COMPLEMENTARY TECHNIQUE IN NOINVASIVE MECHANICAL VENTILATION DURING EXACERBATION OF COPD
Esquinas, A. (1), Carrillo, A. (1), Huidobro, S. (5), Serrano, JM. (2), Gómez, ML. (3) Folgado, M. Á. (4), Quintana, E. (1), Soler, J. A. (1), Gonzalez
Díaz, G (1) . (1) Intensive
Care Unit Hospital Morales Meseguer. Murcia; (2) Intensive Care Unit Hosp Reina Sofia Córdoba, (3)
Hospital General Universitario Ciudad Real. (4) Hospital
Virgen de la Concha Zamora,
(5) Intensive Care Unit, Hospital Universitario de Canarias and IPV Working Group.
Introduction We hypothesized that the use of intrapulmonary percussive
ventilation (IPV) could have some effects in hipercapnia/acidosis and airways
secretions control during treatment with Noninvasive
Mechanical Ventilation ( NIMV) in exacerbations of
COPD associated with bronquial secretions.
Methods The study was performed in a four medical intensive care unit of a university hospitals members of IPV Working Group. We
enrolled COPD exacerbation patients with secretions need NIMV in ICUs. Criteria of exacerbations of COPD with a respiratory frequency
≥ 25/min, a PaCO2 > 45 mmHg and pH ≤ 7.35. We define two
IPV strategies as complementary treatment during NIMV for
evaluate IPV effects. Strategy Group I: NIMV at first line
and combination of IPV in early periods without NIMV in spontaneous breathing
and ph≥7,35. Strategy Group II:
First line of IPV with pipe/face mask and oxygenation previous first
application of NIMV with ph<7,35. In both groups
daily sessions IPV was applied by cicles and time /30
minutes/3 day by pipe or face mask during stay in ICU. NIMV was applied with BiPAP Ventilator
(Respironics) and face mask with BiPAP mode.
Cardiopulmonary monitoring, clinical and arterial blood gases were
evaluated. Therapy was considered successful when patients do not need NIMV
support and clinical and arterial blood gases return baseline.
Results. 65 patients with COPD exacerbation were
admitted in ICU for NIMV, age 70±12, years, male (90%) excluded 15 for severe
hypoxemic ( ≤200 paO2:FiO2) associated in pneumonia (5/65) and cardiac
insufficiency in COPD (10/65). Fifty patients with COPD exacerbation with
secretions were enrolled in two strategy. Strategy Group I. Twenty five (n:25)COPD. Thirty minutes of IPV showed a significant
decrease in respiratory rate, increase in pH respect pre IPV/pCO2 mmHg from [pH:7,26/76,6 mmHg to pH 7,34/76,6 mmHg] after IPV treatment
(p<028; p<043) and improve airway secretions. Strategy Group II. Twenty five (n:25)
COPD, after NIMV with control of arterial blood gases [pH 7,38/52 mmHg] were
treated with IPV treatment improved airway secretions without significant
change in ph/pco2 [pH 7,39/50 mmHg](p<0.162). Hospital stay was
significantly shorter in the IPV group than in the control group (6.8 ± 1.0 vs.
7.9 ± 1.3 days, p < 0.05). UCI stay (G I:3±1; GII:
4±2); failure (GI:1/25; GII:0%).
Conclusion: Trial of IPV session have ventilatory effects in COPD exacerbation associated with
important bronquial secretions and utility as
complementary technique during NIMV.