ABSTRACT
This is a prospective study on the implementation of the non-invasive positive pressure ventilation (NPPV) to treat respiratory failure resulting from exacerbation of chronic obstructive pulmonary disease (COPD) in patients hospitalized in a Pneumological Unit. From January 2000 to January 2003, 39 patients were included during 54 different exacerbation events after being evaluated under international standards. They were classified as severe and very severe patients on the basis of their FEV1 values of 26%. Twenty nine patients presented co-morbidities. As a consequence of the NPPV treatment, the pH values increased between the first and last register as well as the pCO2 dropped in the same period. The initial mean pH values were 7.25 reaching mean values of 7.33 at 2 hours and 7.39 at the discharge; the corresponding pCO2 mean values were 83.8 mmHg, 67.8 mmHg and 54.2 mmHg. Thirty five patients out of 39 were discharged after a mean hospitalization length of 13.6 days. Four patients died. Apropriate training of health care staff in general facilities could allow the implementation of NPPV in addition to usual medical care to treat exacerbation of COPD. High morbidity situations could arise during hospitalization, so invasive ventilation must be necessary.
Subject(s)
Carbon Dioxide/blood , Positive-Pressure Respiration , Pulmonary Disease, Chronic Obstructive , Respiratory Insufficiency/therapy , Aged , Aged, 80 and over , Analysis of Variance , Argentina/epidemiology , Female , Forced Expiratory Volume , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/mortality , Prospective Studies , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/therapy , Respiratory Insufficiency/mortality , Severity of Illness Index , Treatment OutcomeABSTRACT
Se realizó un estudio prospectivo sobre la utilización de la ventilación mecánica no invasiva (VNI) en pacientes internados en Clínica Médica Neumonológica por exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC), con el objetivo de evaluar la evolución, los cambios gasométricos, las comorbilidades y la mortalidad de los pacientes internados. Desde enero 2000 a enero 2003 ingresaron al estudio 39 pacientes, evaluados según normas internacionales en 54 internaciones, siendo clasificados como de grado grave y muy grave, dado que la medición del volumen espiratorio forzado en un segundo (VEF1) era del 26%. Veintinueve pacientes (74.4%) presentaron alguna comorbilidad. Como consecuencia de la aplicación de la VNI, el pH se incrementó entre la primera y tercera medición. El pH promedio inicial fue de 7.25 llegando a 7.33 a las 2 horas y a 7.39 al alta, en tanto que la pCO2 con promedio inicial de 83.8 mm Hg llegó a 67.8 mm Hg y 54.2 mm Hg en el mismo período. Treinta y cinco de los 39 pacientes fueron dados de alta con un período de internación promedio de 13.6 días. Cuatro pacientes (10.3%) fallecieron. Se concluye que con la aplicación de la VNI en pacientes con exacerbación de EPOC, el pH y la PaCO2 cambian significativamente en las muestras sucesivas, y que la adecuada capacitación del equipo de salud puede permitir el tratamiento de estos pacientes en áreas de menor complejidad. Deben ser tenidas en cuenta las posibles complicaciones que pueden sufrir los pacientes durante la internación, que pueden requerir la aplicación de ventilación invasiva.
This is a prospective study on the implementation of the non-invasive positive pressure ventilation (NPPV) to treat respiratory failure resulting from exacerbation of chronic obstructive pulmonary disease (COPD) in patients hospitalized in a Pneumological Unit. From January 2000 to January 2003, 39 patients were included during 54 different exacerbation events after being evaluated under international standards. They were classified as severe and very severe patients on the basis of their FEV1 values of 26%. Twenty nine patients presented co-morbidities. As a consequence of the NPPV treatment, the pH values increased between the first and last register as well as the pCO2 dropped in the same period. The initial mean pH values were 7.25 reaching mean values of 7.33 at 2 hours and 7.39 at the discharge; the corresponding pCO2 mean values were 83.8 mmHg, 67.8 mmHg and 54.2 mmHg. Thirty five patients out of 39 were discharged after a mean hospitalization length of 13.6 days. Four patients died. Apropriate training of health care staff in general facilities could allow the implementation of NPPV in addition to usual medical care to treat exacerbation of COPD. High morbidity situations could arise during hospitalization, so invasive ventilation must be necessary.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Carbon Dioxide/blood , Positive-Pressure Respiration , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Respiratory Insufficiency/therapy , Analysis of Variance , Argentina/epidemiology , Blood Gas Analysis , Comorbidity , Forced Expiratory Volume , Hydrogen-Ion Concentration , Prospective Studies , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/mortality , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Insufficiency/mortality , Severity of Illness Index , Treatment OutcomeABSTRACT
Se realizó un estudio prospectivo sobre la utilización de la ventilación mecánica no invasiva (VNI) en pacientes internados en Clínica Médica Neumonológica por exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC), con el objetivo de evaluar la evolución, los cambios gasométricos, las comorbilidades y la mortalidad de los pacientes internados. Desde enero 2000 a enero 2003 ingresaron al estudio 39 pacientes, evaluados según normas internacionales en 54 internaciones, siendo clasificados como de grado grave y muy grave, dado que la medición del volumen espiratorio forzado en un segundo (VEF1) era del 26%. Veintinueve pacientes (74.4%) presentaron alguna comorbilidad. Como consecuencia de la aplicación de la VNI, el pH se incrementó entre la primera y tercera medición. El pH promedio inicial fue de 7.25 llegando a 7.33 a las 2 horas y a 7.39 al alta, en tanto que la pCO2 con promedio inicial de 83.8 mm Hg llegó a 67.8 mm Hg y 54.2 mm Hg en el mismo período. Treinta y cinco de los 39 pacientes fueron dados de alta con un período de internación promedio de 13.6 días. Cuatro pacientes (10.3%) fallecieron. Se concluye que con la aplicación de la VNI en pacientes con exacerbación de EPOC, el pH y la PaCO2 cambian significativamente en las muestras sucesivas, y que la adecuada capacitación del equipo de salud puede permitir el tratamiento de estos pacientes en áreas de menor complejidad. Deben ser tenidas en cuenta las posibles complicaciones que pueden sufrir los pacientes durante la internación, que pueden requerir la aplicación de ventilación invasiva.(AU)
This is a prospective study on the implementation of the non-invasive positive pressure ventilation (NPPV) to treat respiratory failure resulting from exacerbation of chronic obstructive pulmonary disease (COPD) in patients hospitalized in a Pneumological Unit. From January 2000 to January 2003, 39 patients were included during 54 different exacerbation events after being evaluated under international standards. They were classified as severe and very severe patients on the basis of their FEV1 values of 26%. Twenty nine patients presented co-morbidities. As a consequence of the NPPV treatment, the pH values increased between the first and last register as well as the pCO2 dropped in the same period. The initial mean pH values were 7.25 reaching mean values of 7.33 at 2 hours and 7.39 at the discharge; the corresponding pCO2 mean values were 83.8 mmHg, 67.8 mmHg and 54.2 mmHg. Thirty five patients out of 39 were discharged after a mean hospitalization length of 13.6 days. Four patients died. Apropriate training of health care staff in general facilities could allow the implementation of NPPV in addition to usual medical care to treat exacerbation of COPD. High morbidity situations could arise during hospitalization, so invasive ventilation must be necessary.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Positive-Pressure Respiration , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Carbon Dioxide/blood , Respiratory Insufficiency/therapy , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/mortality , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Insufficiency/mortality , Treatment Outcome , Hydrogen-Ion Concentration , Prospective Studies , Analysis of Variance , Argentina/epidemiology , Forced Expiratory Volume , Blood Gas Analysis , Severity of Illness Index , ComorbidityABSTRACT
Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals located in the surroundings of Buenos Aires city. Fifty two patients from General Hospital Manuel Belgrano (HMB) were included from March 1998 to February 1999 and 23 patients from Hospital Dr A. Cetrangolo (HCET) for respiratory disease, were included from June 2000 to May 2001. Patients with lung tuberculosis, lung neoplasia and HIV infection were excluded. Clinical background, signs and symptoms were recorded. Microbiological examinations performed included bacteria, respiratory viruses and mycobacteria. Studies for "atypical" bacteria (Chlamydia spp., Coxiella burnetii, Mycoplasma pneumoniae and Legionella spp.) were carried out by serological methods. No differences in age and gender were observed between both groups. Most frequently observed comorbidities in the HMB group included COPD, diabetes and cardiac failure while in the HCET group these were COPD, asthma and lung fibrosis. Etiology was established in 48% and 65.2% of the patients in the first and second group, respectively. Most frequent agents were Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A and Legionella spp.; the last one was detected in 12% of the patients. Most of these patients were from HMB and presented a good outcome. Mortality was similar in both groups (13.3%). In the HBM group it was related to the presence of comorbidities in 7 out of 8 cases, and in the HCET group it was a consequence of the worsening of their chronic respiratory failure.
Subject(s)
Pneumonia, Bacterial/microbiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Argentina/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Comorbidity , Female , Humans , Influenza A virus/isolation & purification , Male , Middle Aged , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Bacterial/mortality , Prospective Studies , Risk Factors , Sex Distribution , Streptococcus pneumoniae/isolation & purificationABSTRACT
Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals located in the surroundings of Buenos Aires city. Fifty two patients from General Hospital Manuel Belgrano (HMB) were included from March 1998 to February 1999 and 23 patients from Hospital Dr A. Cetrangolo (HCET) for respiratory disease, were included from June 2000 to May 2001. Patients with lung tuberculosis, lung neoplasia and HIV infection were excluded. Clinical background, signs and symptoms were recorded. Microbiological examinations performed included bacteria, respiratory viruses and mycobacteria. Studies for "atypical" bacteria (Chlamydia spp., Coxiella burnetii, Mycoplasma pneumoniae and Legionella spp.) were carried out by serological methods. No differences in age and gender were observed between both groups. Most frequently observed comorbidities in the HMB group included COPD, diabetes and cardiac failure while in the HCET group these were COPD, asthma and lung fibrosis. Etiology was established in 48% and 65.2% of the patients in the first and second group, respectively. Most frequent agents were Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A and Legionella spp.; the last one was detected in 12% of the patients. Most of these patients were from HMB and presented a good outcome. Mortality was similar in both groups (13.3%). In the HBM group it was related to the presence of comorbidities in 7 out of 8 cases, and in the HCET group it was a consequence of the worsening of their chronic respiratory failure
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pneumonia, Bacterial , Age Distribution , Aged, 80 and over , Argentina , Community-Acquired Infections , Comorbidity , Influenza A virus , Mycoplasma pneumoniae , Pneumonia, Bacterial , Prospective Studies , Risk Factors , Sex Distribution , Streptococcus pneumoniaeABSTRACT
Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals located in the surroundings of Buenos Aires city. Fifty two patients from General Hospital Manuel Belgrano (HMB) were included from March 1998 to February 1999 and 23 patients from Hospital Dr A. Cetrangolo (HCET) for respiratory disease, were included from June 2000 to May 2001. Patients with lung tuberculosis, lung neoplasia and HIV infection were excluded. Clinical background, signs and symptoms were recorded. Microbiological examinations performed included bacteria, respiratory viruses and mycobacteria. Studies for "atypical" bacteria (Chlamydia spp., Coxiella burnetii, Mycoplasma pneumoniae and Legionella spp.) were carried out by serological methods. No differences in age and gender were observed between both groups. Most frequently observed comorbidities in the HMB group included COPD, diabetes and cardiac failure while in the HCET group these were COPD, asthma and lung fibrosis. Etiology was established in 48% and 65.2% of the patients in the first and second group, respectively. Most frequent agents were Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A and Legionella spp.; the last one was detected in 12% of the patients. Most of these patients were from HMB and presented a good outcome. Mortality was similar in both groups (13.3%). In the HBM group it was related to the presence of comorbidities in 7 out of 8 cases, and in the HCET group it was a consequence of the worsening of their chronic respiratory failure (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Pneumonia, Bacterial/microbiology , Aged, 80 and over , Prospective Studies , Argentina/epidemiology , Community-Acquired Infections/mortality , Comorbidity , Risk Factors , Mycoplasma pneumoniae/isolation & purification , Streptococcus pneumoniae/isolation & purification , Sex Distribution , Age Distribution , Influenza A virus/isolation & purification , Pneumonia, Bacterial/mortality , Community-Acquired Infections/microbiologyABSTRACT
Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals located in the surroundings of Buenos Aires city. Fifty two patients from General Hospital Manuel Belgrano (HMB) were included from March 1998 to February 1999 and 23 patients from Hospital Dr A. Cetrangolo (HCET) for respiratory disease, were included from June 2000 to May 2001. Patients with lung tuberculosis, lung neoplasia and HIV infection were excluded. Clinical background, signs and symptoms were recorded. Microbiological examinations performed included bacteria, respiratory viruses and mycobacteria. Studies for [quot ]atypical[quot ] bacteria (Chlamydia spp., Coxiella burnetii, Mycoplasma pneumoniae and Legionella spp.) were carried out by serological methods. No differences in age and gender were observed between both groups. Most frequently observed comorbidities in the HMB group included COPD, diabetes and cardiac failure while in the HCET group these were COPD, asthma and lung fibrosis. Etiology was established in 48
and 65.2
of the patients in the first and second group, respectively. Most frequent agents were Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A and Legionella spp.; the last one was detected in 12
of the patients. Most of these patients were from HMB and presented a good outcome. Mortality was similar in both groups (13.3
). In the HBM group it was related to the presence of comorbidities in 7 out of 8 cases, and in the HCET group it was a consequence of the worsening of their chronic respiratory failure.