מתוך medicontext.co.il
LONDON (Reuters Health) – Arterial blood gases and pH can help identify patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) who can be treated with noninvasive ventilation instead of intubation, according to a report by UK researchers in the September issue of Thorax.
Dr. P. K. Plant from St. James's University Hospital in Leeds and colleagues randomly assigned 118 COPD patients to noninvasive ventilation and 118 to standard therapy to develop predictors of success and failure of treatment, and to evaluate long-term survival associated with the two treatment options.
Multivariate analysis showed that factors associated with treatment failure were the severity of acidosis (odds ratio 1.22 per H+ nmol/L, p < 0.01) and PaCO2 (odds ratio 1.14 per kPa, p < 0.01) at the beginning of treatment.
Factors associated with the success of therapy over 4 hours were a fall in respiratory rate (odds ratio 0.92 per breaths/min, p = 0.04) and a fall in H+ concentration (odds ratio 0.89 per nmol/L, p < 0.01).
The median survival for all the patients was 15.9 months. There was a nonsignificant trend to improved survival among patients who received noninvasive ventilation, with a median survival of 16.8 months in the noninvasive ventilation group compared with 13.4 months for patients receiving standard treatment, Dr. Plant's group found.
"This study shows that long-term survival after noninvasive ventilation for acute exacerbations of COPD is worthwhile and identifies factors which can be used to monitor patients during the in-hospital period," Dr. Plant and colleagues conclude.
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