Effects of noninvasive positive pressure ventilation in COPD with hypercapnic coma secondary to respiratory failure_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Xiu , WANG Tong , DING Zhen , CHEN Ruojing , ZHANG Chunmei , WU Zufeng , ZHANG Suping

Department of Respiratory Medicine，The 1st People’s Hospital of Hefei.Hefei，Anhui，230061，ChinaCorresponding Author：LI Xiu，Email：huxike@hotmail.com;

Corresponding author：

Keywords：

Chronic obstructive pulmonary disease; Respiratory failure; Hypercapnia; Coma; Noninvasive positive pressure ventilation

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Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (P gt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，P gt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.

Citation： LI Xiu,WANG Tong,DING Zhen,CHEN Ruojing,ZHANG Chunmei,WU Zufeng,ZHANG Suping. Effects of noninvasive positive pressure ventilation in COPD with hypercapnic coma secondary to respiratory failure. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(2): 114-118. doi: Copy

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1. Hill NS.Noninvasive positive pressure ventilation for respiratory failure caused by exacerbations of chronic obstructive pulmonary disease：a standard of care? Crit Care，2003，7：400-401.
2. Criner GJ，Brennan K，Travaline JM，et al.Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure.Chest，1999，116：667-675.
3. Celikel T，Sungur M，Ceyhan B，et al.Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure.Chest，1998，114：1636-1642.
4. 李秀，陈若静，吴祖凤，等.BiPAP治疗COPDⅡ型呼吸衰竭的疗效观察.安徽医学，2006，27：169-171.
5. 李坚，张德厚，孙丽萍等.无创正压通气救治慢性阻塞性肺疾病呼吸衰竭后期失败的相关因素分析.中国呼吸与危重监护杂志，2003，2：100-103.
6. Keenan P，Sinuff T，Cook DJ，et al.Which Patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure Ventilation? Ann Inter Med，2003，138：861-870.
7. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南.中华内科杂志，2002，41：640-646.
8. 中华医学会呼吸病学会临床呼吸生理及ICU组.无创正压通气临床应用中的几点建议.中华结核和呼吸杂志，2002，25：130-134.
9. 王华静，张琴，李艳等.呼吸机相关肺炎的病因及防治对策.中华医院感染学杂志，2004，14：1232-1233.
10. Diaz GG，Alcaraz AC，Talavera JC，et al.Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure.Chest，2005，127：952-960.
11. 朱光发，张蔚，宗华，等.无创正压通气治疗慢性阻塞性肺疾病呼吸衰竭伴意识障碍的临床研究.中国呼吸与危重监护杂志，2006，5：332-336.
12. 朱蕾，钮善福，李燕芹，等.经面罩机械通气治疗慢性阻塞性肺病呼吸衰竭昏迷患者的疗效评价.中国危重病急救医学，1997，9：28-31.
13. 王吉耀，主编.内科学.人民卫生出版社，2005，47.
14. 朱蕾，钮善福，主编.机械通气.上海科学技术出版社，2001，106.
15. 朱蕾，钮善福，主编.机械通气.上海科学技术出版社，2001，302.
16. 朱蕾，钮善福，主编.机械通气.上海科学技术出版社，2001，306.
17. 王保国，主编.实用呼吸机治疗学，人民卫生出版社，1994，95-96.
18. 朱蕾，刘又宁，于润江，主编.临床肺功能.人民卫生出版社，2004，62-63.
19. Esteban A，Frutos-Vivar F，Ferguson ND，et al.Noninvasive positive-pressure ventilation for respiratory failure after extubation.N Engl J Med，2004，350：2452-2460.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of noninvasive positive pressure ventilation in COPD with hypercapnic coma secondary to respiratory failure

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