[Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study]. / Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo.

BACKGROUND: In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS: 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patient's discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS: The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO2 and PaO2/FiO2. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION: NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.

Predictors of long-term survival in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To analyze the factors affecting survival of patients with chronic obstructive pulmonary disease (COPD) during the follow-up period using a 4-year prospective study. METHODS: The study included 276 out-patients with COPD. The study took place in Ankara University, Cebeci Hospital, Ankara, Turkey between September 2000 and January 2005. We used cox proportional hazards model in investigating the effects of clinical variables on survival. Risk factors related with mortality were analyzed. RESULTS: Forty-nine patients (17.8%) died and the mean survival time was 43.40 +/- 0.65 months. The survival rates were 97% at one year, 89% at 2 years, 84% at 3 years, and 73% at 4 years. Cox proportional hazard model revealed that long-term mortality was significantly associated with age (relative risks [RR]: 1.13, 95% confidence interval: 1.09-1.17), the level of dyspnea (RR: 1.99, 95% confidence interval: 1.44-2.74), the number of hospital admission for acute exacerbation of COPD (RR: 1.33, 95% CI: 1.07-1.67) and the number of scheduled physician visits (RR: 0.75, 95% CI: 0.58-0.95). Also, the presence of hypoxemia was correlated with survival of COPD patients (RR: 0.99, 95% CI: 95-1.00). CONCLUSION: Patient's age, level of dyspnea, hypoxemia and the number of hospital admission were more closely correlated with mortality in COPD. The regular follow-up patients increased the survival of this disease. According to this study patients with COPD may be followed in the specialized out-patient COPD clinics to decrease their morbidity and mortality rates.