Hypercapnic Respiratory Failure in COPD Patients
2000; Elsevier BV; Volume: 117; Issue: 1 Linguagem: Inglês
10.1378/chest.117.1.169
ISSN1931-3543
AutoresGuy W. Soo Hoo, Navid Hakimian, Silverio Santiago,
Tópico(s)Nosocomial Infections in ICU
ResumoIntroduction The clinical course of patients withacute exacerbations of underlying COPD presenting with hypercapnicrespiratory failure was reviewed. Methods This was aretrospective review of 138 episodes of hypercapnic respiratory failure(Paco2 ≥ 50 mm Hg and pH ≤ 7.35). Patientswere admitted to the West Los Angeles VAMC Medical Intensive Care Unitbetween 1990 and 1994. Results Of the 138 hypercapnicepisodes, 74 (54%) required intubation. Comparison was made with the64 cases in which patients responded to medical therapy. Patientsrequiring intubation had a greater severity of illness, with a higherAPACHE II (Acute Physiology and Chronic Health Evaluation II) score(18 ± 5 vs 16 ± 4; p < 0.01), higher WBC, higher serum BUN, and greater acidosis (pH, 7.26 ± 0.07 vs 7.28 ± 0.06;p = 0.08). Those with the most severe acidosis (pH < 7.20) had thehighest intubation rate (70%) and shortest time to intubation(2 ± 2 h), and they required the longest period of time to respondto medical therapy (69 ± 60 h). With an initial pH of < 7.25, there was a consistently higher intubation rate. Conversely, those withan initial pH of 7.31 to 7.35 were less likely to be intubated (45%), had a longer time to intubation (13 ± 18 h), and had a more rapidresponse to medical therapy (30 ± 18 h). Of those patients requiringintubation, most (78%) were intubated within 8 h of presentation, and the vast majority (93%) by 24 h. Of those patients respondingto medical therapy, half (52%) recovered within 24 h and the vastmajority (92%) recovered within 72 h. Conclusions This study provides a better characterizationof the response to therapy of COPD patients with hypercapnicrespiratory failure. This should be useful in limiting or omittingmedical therapy in high-risk patients, thereby avoiding delays inintubation as well as providing a framework for continued therapy inthose more likely to improve.
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