Influence of High Fraction of Inspired Oxygen on PaCO<sub>2</sub> During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WangJinrong , GaoPan , GuoShufen , LiuYajing , LiuShuhong , GaoXiuling ,  CuiZhaobo

Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei, 053000, China;

Corresponding author：

CuiZhaobo, Email: zhaobocui2014@sina.com

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Noninvasive ventilation; Fraction of inspired oxygen; Carbon dioxide retention

DOI：

10.7507/1671-6205.2016078

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Objective To investigate the safety of high fraction of inspired oxygen (FiO₂)during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and carbon dioxide (CO₂)retention. Methods Fifty-six AECOPD patients with CO₂ retention admitted between March 2013 and August 2015 were recruited in the study.All patients received noninvasive ventilation treatment with FiO₂<0.5.After stabilization of acute respiratory crisis,FiO₂ was increased to 1.0 and lasted for 40 minutes.The changes of tidal volume,respiratory frequency,minute volume,Glasgow coma score,arterial blood gas and SpO₂ were observed before and after the FiO₂ reset. Results The mean PaO₂ increased from (83±14)mm Hg to (165±41)mm Hg and the mean SpO₂ increased from (92.4±3.1)% to (97.8±1.9)% significantly (both P<0.001).The mean PaCO₂ did not changed obviously from (72±15)mm Hg to (72±14)mm Hg (P=0.438).There were also no significant changes in any of the other parameters. Conclusion During noninvasive ventilation with an FiO₂ sufficient to maintain a normal PaO₂,an increase in FiO₂ does not further increase PaCO₂ level in AECOPD patients with CO₂ retention.

Citation： WangJinrong, GaoPan, GuoShufen, LiuYajing, LiuShuhong, GaoXiuling, CuiZhaobo. Influence of High Fraction of Inspired Oxygen on PaCO₂ During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 329-332. doi: 10.7507/1671-6205.2016078 Copy

1.	慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版).国际呼吸杂志,2014,34:1-11.
2.	Barbera JA,Roca J,Ferrer A,et al.Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease.Eur Respir J,1997,10:1285-1291.
3.	Diaz O,Iglesia R,Ferrer M,et al.Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1997,156:1840-1845.
4.	Hill NS.Noninvasive ventilation for chronic obstructive pulmonary disease.Respir Care,2004,49:72-87;discussion 87-79.
5.	Crossley DJ,McGuire GP,Barrow PM,et al.Influence of inspired oxygen concentration on deadspace,respiratory drive,and PaCO₂ in intubated patients with chronic obstructive pulmonary disease.Crit Care Med,1997,25:1522-1526.
6.	Pauwels RA,Buist AS,Calverley PM,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2014,163:1256-1276.
7.	Cano NJ,Pichard C,Court-Fortune I,et al.Survival of patients with chronic respiratory failure on long-term oxygen therapy and or non-invasive ventilation at home.Clin Nutr,2015,34:739-744.
8.	Bone RC.Treatment of respiratory failure due to advanced chronic obstructive lung disease.Arch Intern Med,1980,140:1018-1021.
9.	DeGaute JP,Domenighetti G,Naeije R,et al.Oxygen delivery in acute exacerbation of chronic obstructive pulmonary disease.Effects of controlled oxygen therapy.Am Rev Respir Dis,1981,124:26-30.
10.	Savi A,Gasparetto Maccari J,Frederico Tonietto T,et al.Influence of FIO₂ on PaCO₂ during noninvasive ventilation in patients with COPD.Respir Care,2014,59:383-387.
11.	Sassoon CS,Hassell KT,Mahutte CK.Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary disease.Am Rev Respir Dis,1987,135:907-911.
12.	Aubier M,Murciano D,Milic-Emili J,et al.Effects of the administration of O₂ on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure.Am Rev Respir Dis,1980,122:747-754.
13.	Dick CR,Liu Z,Sassoon CS,et al.O₂-induced change in ventilation and ventilatory drive in COPD.Am J Respir Crit Care Med,1997,155:609-614.
14.	Hanson CW 3rd,Marshall BE,Frasch HF,et al.Causes of hypercarbia with oxygen therapy in patients with chronic obstructive pulmonary disease.Crit Care Med,1996,24:23-28.
15.	Scano G,Spinelli A,Duranti R,et al.Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia.Eur Respir J,1995,8:78-85.

1. 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版).国际呼吸杂志,2014,34:1-11.
2. Barbera JA,Roca J,Ferrer A,et al.Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease.Eur Respir J,1997,10:1285-1291.
3. Diaz O,Iglesia R,Ferrer M,et al.Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1997,156:1840-1845.
4. Hill NS.Noninvasive ventilation for chronic obstructive pulmonary disease.Respir Care,2004,49:72-87;discussion 87-79.
5. Crossley DJ,McGuire GP,Barrow PM,et al.Influence of inspired oxygen concentration on deadspace,respiratory drive,and PaCO₂ in intubated patients with chronic obstructive pulmonary disease.Crit Care Med,1997,25:1522-1526.
6. Pauwels RA,Buist AS,Calverley PM,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2014,163:1256-1276.
7. Cano NJ,Pichard C,Court-Fortune I,et al.Survival of patients with chronic respiratory failure on long-term oxygen therapy and or non-invasive ventilation at home.Clin Nutr,2015,34:739-744.
8. Bone RC.Treatment of respiratory failure due to advanced chronic obstructive lung disease.Arch Intern Med,1980,140:1018-1021.
9. DeGaute JP,Domenighetti G,Naeije R,et al.Oxygen delivery in acute exacerbation of chronic obstructive pulmonary disease.Effects of controlled oxygen therapy.Am Rev Respir Dis,1981,124:26-30.
10. Savi A,Gasparetto Maccari J,Frederico Tonietto T,et al.Influence of FIO₂ on PaCO₂ during noninvasive ventilation in patients with COPD.Respir Care,2014,59:383-387.
11. Sassoon CS,Hassell KT,Mahutte CK.Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary disease.Am Rev Respir Dis,1987,135:907-911.
12. Aubier M,Murciano D,Milic-Emili J,et al.Effects of the administration of O₂ on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure.Am Rev Respir Dis,1980,122:747-754.
13. Dick CR,Liu Z,Sassoon CS,et al.O₂-induced change in ventilation and ventilatory drive in COPD.Am J Respir Crit Care Med,1997,155:609-614.
14. Hanson CW 3rd,Marshall BE,Frasch HF,et al.Causes of hypercarbia with oxygen therapy in patients with chronic obstructive pulmonary disease.Crit Care Med,1996,24:23-28.
15. Scano G,Spinelli A,Duranti R,et al.Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia.Eur Respir J,1995,8:78-85.

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Influence of High Fraction of Inspired Oxygen on PaCO₂ During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD

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Influence of High Fraction of Inspired Oxygen on PaCO2 During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD

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Influence of High Fraction of Inspired Oxygen on PaCO₂ During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD