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Noninvasive Ventilation to Extubation for COPD Patients With ST-Segment Elevation Myocardial Infarction: A Prospective Study
Critical Care SESSION TITLE: Improving Outcomes in the ICU SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 02:45 PM - 04:15 PM
Noninvasive Ventilation to Extubation for COPD Patients With ST-Segment Elevation Myocardial Infarction: A Prospective Study Boxue Han* and Ying Wang PLA Rocket Forced General Hospital (the former PLA The Second Artillery General Hospital), Beijing, China PURPOSE: To evaluate the role of non-invasive ventilation mode with auto-titrating EPAP level in decreasing adverse effects post-extubation,reintubation and improving patient-ventilator synchronization comfort for COPD patients with ST-segment elevation myocardial infarction.
CRITICAL CARE
METHODS: A prospective randomized controlled study,52 elderly COPD patients intubated for acute respiratory failure (ARF), who complicated with ST-segment elevation myocardial Infarction(STEMI). All subjects got readiness to wean and extubate(myocardial enzymes was normal but NT-proBNP$1800pg/ml)were divided into two groups: auto-EPAP group (26 cases) and fixed-EPAP group(26 cases), depending on ventilation mode.Parameters in Auto-EPAP group:AVAPS-AE(average volume assured pressure support auto-titrating EPAP) mode, maximum EPAP=15cmH2O,minimum EPAP=5cmH2O, IPAP:12～ 20cmH2O, Rate=3cm H2O/min, tidal volume depending on individual BMI. Parameters in fixed-EPAP group:AVAPS(average volume assured pressure support) mode, the same parameters above were adopted in fixed-EPAP group except the level of EPAP(EPAP=8cmH2O,which equals that in pre-extubation).Both groups were accepted with oxygen therapy( FiO2:50%～65%) , heparin anticoagulation (100IU/kg/d),expansion of coronary artery and other basic therapies. Besides,the patients were requried for fasting and gastrointestinal decompression before and after extubation.The primary endpoints were reintubation within 14 days after extubation,abdominal distension and patient-ventilator asynchronization. Secondary endpoints: the arterial blood gas,heart rate,respiratory rate, Borg score and recurrence rate of myocardial Infarction and angina pectoris.Morever, degree of patients’ comfort during NIV was measured by the VAS (Visual Analog Scale) RESULTS: 1.Reintubation rates within 14 days were 15.3% and 3.8% in fixed-EPAP and auto- EPAP groups respectively (p<0.05). 2. Compared with fixed-EPAP group,the main results were a higher VAS score (p<0.001),lower incidence of patientventilator asynchrony and abdominal distension in auto-EPAP group(p<0.005). 3. Lower occurrence of angina pectoris in autoEPAP group than that in fixed-EPAP group (p<0.0001)，no difference in recurrence rate of myocardial Infarction and malignant arrhythmia in both groups(p>0.05). 4.The 0.5th and 1 st hours after extubation, there was a greater decrease in PCO2 and increase in PO2 and PH in auto-EPAP than in fixed-EPAP group(p<0.05). No difference was found in the blood PH and Borg Score at the 48th hour postextubation(p>0.05). The recovery duration of shortness after extubation was 4.2 minutes shorter in auto-EPAP group (p<0.001). CONCLUSIONS: This finding suggest that the level of EPAP set in non-invasive ventilation to extubation for COPD patients with STEMI should be a varying range rather than a fixed and strict parameter. AVAPS-AE mode maybe more likely to improve patient-ventilator synchronization comfort, and decrease adverse effects post-extubation. CLINICAL IMPLICATIONS: The potential advantages of AVAPS-AE mode tend to be able to supply with appropriate EPAP levels, which maybe adjust to changing levels of PEEP after extubation in COPD patients with STEMI, and even determine successful likelihood of extubation to noninvasive ventilation, worthy of promotion. DISCLOSURE: The following authors have nothing to disclose: Boxue Han, Ying Wang No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.368
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
342A
[
152#4S CHEST OCTOBER 2017
]
Noninvasive Ventilation to Extubation for COPD Patients With ST-Segment Elevation Myocardial Infarction: A Prospective Study Boxue Han* and Ying Wang PLA Rocket Forced General Hospital (the former PLA The Second Artillery General Hospital), Beijing, China PURPOSE: To evaluate the role of non-invasive ventilation mode with auto-titrating EPAP level in decreasing adverse effects post-extubation,reintubation and improving patient-ventilator synchronization comfort for COPD patients with ST-segment elevation myocardial infarction.
CRITICAL CARE
METHODS: A prospective randomized controlled study,52 elderly COPD patients intubated for acute respiratory failure (ARF), who complicated with ST-segment elevation myocardial Infarction(STEMI). All subjects got readiness to wean and extubate(myocardial enzymes was normal but NT-proBNP$1800pg/ml)were divided into two groups: auto-EPAP group (26 cases) and fixed-EPAP group(26 cases), depending on ventilation mode.Parameters in Auto-EPAP group:AVAPS-AE(average volume assured pressure support auto-titrating EPAP) mode, maximum EPAP=15cmH2O,minimum EPAP=5cmH2O, IPAP:12～ 20cmH2O, Rate=3cm H2O/min, tidal volume depending on individual BMI. Parameters in fixed-EPAP group:AVAPS(average volume assured pressure support) mode, the same parameters above were adopted in fixed-EPAP group except the level of EPAP(EPAP=8cmH2O,which equals that in pre-extubation).Both groups were accepted with oxygen therapy( FiO2:50%～65%) , heparin anticoagulation (100IU/kg/d),expansion of coronary artery and other basic therapies. Besides,the patients were requried for fasting and gastrointestinal decompression before and after extubation.The primary endpoints were reintubation within 14 days after extubation,abdominal distension and patient-ventilator asynchronization. Secondary endpoints: the arterial blood gas,heart rate,respiratory rate, Borg score and recurrence rate of myocardial Infarction and angina pectoris.Morever, degree of patients’ comfort during NIV was measured by the VAS (Visual Analog Scale) RESULTS: 1.Reintubation rates within 14 days were 15.3% and 3.8% in fixed-EPAP and auto- EPAP groups respectively (p<0.05). 2. Compared with fixed-EPAP group,the main results were a higher VAS score (p<0.001),lower incidence of patientventilator asynchrony and abdominal distension in auto-EPAP group(p<0.005). 3. Lower occurrence of angina pectoris in autoEPAP group than that in fixed-EPAP group (p<0.0001)，no difference in recurrence rate of myocardial Infarction and malignant arrhythmia in both groups(p>0.05). 4.The 0.5th and 1 st hours after extubation, there was a greater decrease in PCO2 and increase in PO2 and PH in auto-EPAP than in fixed-EPAP group(p<0.05). No difference was found in the blood PH and Borg Score at the 48th hour postextubation(p>0.05). The recovery duration of shortness after extubation was 4.2 minutes shorter in auto-EPAP group (p<0.001). CONCLUSIONS: This finding suggest that the level of EPAP set in non-invasive ventilation to extubation for COPD patients with STEMI should be a varying range rather than a fixed and strict parameter. AVAPS-AE mode maybe more likely to improve patient-ventilator synchronization comfort, and decrease adverse effects post-extubation. CLINICAL IMPLICATIONS: The potential advantages of AVAPS-AE mode tend to be able to supply with appropriate EPAP levels, which maybe adjust to changing levels of PEEP after extubation in COPD patients with STEMI, and even determine successful likelihood of extubation to noninvasive ventilation, worthy of promotion. DISCLOSURE: The following authors have nothing to disclose: Boxue Han, Ying Wang No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.368
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
342A
[
152#4S CHEST OCTOBER 2017
]