[Evolution of patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or congestive heart failure in a respiratory monitoring unit]. / Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria.

OBJECTIVE: We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic groups response to therapy in terms of clinical course and evolution of blood gases. PATIENTS AND METHODS: Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode. RESULTS: No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO2 worsened for COPD patients (P = .026) and PaO2 improved for CHF patients (P = .028). After 1 to 3 hours of NIV, pH (P = .002) and PaO2 (P = .041) improved for COPD patients, and pH (P = .03) and PaCO2 (P = .045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, P = .076). CONCLUSIONS: In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered.

Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria / Evolution of patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or congestive heart failure in a respiratory monitoring unit

OBJETIVO: Hemos realizado un trabajo comparativo en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), síndrome de hipoventilación-obesidad (SHO) e insuficiencia cardíaca congestiva (ICC) sometidos a ventilación no invasiva (VNI) en una unidad de monitorización de neumología por presentar acidosis hipoxémica-hipercápnica. El objetivo ha sido valorar la respuesta clínica y gasométrica en función del diagnóstico. PACIENTES Y MÉTODOS: Se trata de un estudio prospectivo (12 mese de duración) en 53 pacientes con acidosis hipoxémic-hipercápnica, de los que 27 presentaban EPOC; 17, SHO, y 9, ICC. Realizamos un análisis de la gravedad gasométrica inicial, de la evolución gasométrica (tras tratamiento convencional y tras VNI a las 1-3h y 12-24h) y de la mortalidad. Todos ellos recibieron VNI tipo BiPAP en modo asistido-controlado. RESULTADOS: LA presentación gasométrica inicial era similar en las 3 entidades (valores medios +/- desviación estándar de pH, 7,28 +/- 0,1 en la EPOC; 7,29 +/- 0,09 en SHO, y 7,24 +/- 0,07 en ICC; no significativo). Tras tratamiento convencional inicial, en los pacientes con EPOC se observó un empeoramiento de la presión arterial de anhídrido carbónico (p=0,026), y en aquellos con ICC, una mejoría de la presión arterial de oxígeno (p=0,028). Tras el inico de la VNI (1-3h) se produjo una mejoría del pH (p=0,002) y de la presión arterial de oxígeno (p=0,041) en la EPOC, y del pH (p=0,03) y de la presión arterial de anhídrido carbónico (o=0,045) en el SHO; no hubo cambios significativos en la ICC. Tras 12-24h con VNI, el pH fue de 7,36 +/- 0,04 en la EPOC, de 7,36 +/- 0,05 en el SHO y de 7,25 +/- 0,1 (no significativo) en la ICC. La mortalidad fue del 11,1% en la EPOC, del 0% en el SHO y del 33% en la ICC (no significativo; p= 0,076). CONCLUSIONES: Partiendo de una gravedad gasométrica similar, en el SHO y la EPOC se observó una mejor respuesta a la VNI que en la ICC. El inicio de la VNI suele precederse de mala respuesta al tratamiento convencional en la EPOC, lo que haría replantearse la demora para iniciarla

OBJECTIVE: We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic groups response to therapy in terms of clinical course and evolution of blood gases. PATIENTS AND METHODS: Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode. RESULTS: No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO2 worsened for COPD patients (P=.026) and PaO2 improved for CHF patients (P=.028). After 1 to 3 hours of NIV, pH (P=.002) and PaO2 (P=.041) improved for COPD patients, and pH (P=.03) and PaCO2 (P=.045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, P=.076). CONCLUSIONS: In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered