Asistencia ventilatoria no invasiva en el tratamiento inicial de la insuficiencia respiratoria aguda

Ana Graciela França; Carlos Ignacio Formento; Soledad Olivera; Alejandro Ebeid Bocchi

Authors

Ana Graciela França Círculo Católico de Obreros del Uruguay, CTI. Jefe. Médico Intensivista
Carlos Ignacio Formento Círculo Católico de Obreros del Uruguay. Médico Intensivista
Soledad Olivera Médico Residente de Medicina Intensiva
Alejandro Ebeid Bocchi Círculo Católico de Obreros del Uruguay, Coordinador de CTI. Médico Intensivista

Keywords:

ARTIFICIAL RESPIRATION, RESPIRATORY INSUFFICIENCY, ACUTE DISEASE

Abstract

Introduction: invasive mechanic ventilation implies increased risk of pneumonia and traumatic damage of the airway. Non-invasive ventilation proved benefits in acute respiratory failure, in chronic obstructive pulmonary disease (COPD) and in acute cardiogenic pulmonary edema (CPE), although it resulted heterogeneous in non-cardiogenic pulmonary edema hypoxemic respiratory failure.
Objectives: to evaluate non-invasive ventilation in hypoxemic and hypercapnic acute respiratory failure as an initial treatment. Response, evolution, risk of failure and death.
Method: prospective cohort study that included immunocompetent adults treated with non-invasive ventilation. Period: January, 2011 through July, 2013. The study included patients with hypercapnic acute respiratory failure hospitalized in a 16 bed ICU: carbon dioxide blood pressure (PaCO2) ≥45 mm Hg, and pH ≤7.35 and >7.25, or hypoxemic acute respiratory failure: oxygen blood pressure (PaO2) with oxygen mask >80 and ≤150 mmHg. Patients would be excluded if there was an indication of immediate intubation, sensory depression, hemodynamic instability, bronchoplegia.
Results: the study comprised 61 patients, 62 ± 14 years old (average age ± 1 standard deviation). Apache II scores were 15 ± 5.5. Thirty six patients had hypoxemic acute respiratory failure, 9 of them failed (25%) and 7 died (19%); there were 25 patients with hypercapnic acute respiratory failure, 5 of them failed (20%) and 4 died (16%).
Those who failed had a longer hospitalization, p=0.01, a higher incidence of respiratory infections, and extra-respiratory infections p=0.03. The independent risk factors associated to failure and death (logistic regression) were the following:
· Failure: every unit increase in the respiratory rate in the first hour of non-invasive ventilation, odds ratio (OR) 2.2 (IC 95% 1.4-3.5).
· Death: failure of the non-invasive ventilation, OR 19.5 (IC 95% 4.0-94.6).
Conclusions: each increase of the respiratory rate in the first hour of non-invasive ventilation doubles the risk of failure and the latter multiplies by twenty the probability of death.

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