The Science Journal of the American Association for Respiratory Care

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.


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