High Pressure Non Invasive Ventilation in Hypercapnic Respiratory Failure
关键词
抽象
描述
Noninvasive ventilation (NIV): refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube). NPPV is well established in the management of acute on chronic hypercapnic respiratory failure secondary to acute exacerbation of COPD (AECOPD), obesity hypoventilation syndrome, and restrictive thoracic disorders.
During the past years NIV was applied by using low pressure inspiratory positive airway pressure (IPAP), which means titrating inspiratory pressure starting at 10 cmH2O and increasing pressure gradually according to patient tolerance maximum up to 20 cm H2O.
There is still about 15% failure rate while using conventional low pressure NIV, this failure rate may be attributed to the following:
1. Still in a number of patients with conventional low pressure NIV, PaCO2, and pH worsen with subsequent deterioration and need for invasive ventilation.
2. Despite lowering PaCO2 value with conventional NIV ventilation but it is not normalized so with minimal derangement in clinical condition of the patient it worsens again.
3. Also abnormally high level PaCO2 may have a negative impact on vital organs.
4. Low pressure may be associated with patient intolerance , and discontinuation of NIV.
Recently high pressure NIV used aiming to improve outcome of NIV. High pressure NIV is a pressure limited ventilation, stating IPAP pressure at 20 cmH2O and gradually increasing pressure up to 30 cmH2O according to patient tolerance. High pressure NIV is expected to improve alveolar ventilation, decreasing dead space ventilation, and work of breathing, so it can improve the outcome result .
日期
| 最后验证: | 06/30/2020 |
| 首次提交: | 04/22/2020 |
| 提交的预估入学人数: | 04/22/2020 |
| 首次发布: | 04/26/2020 |
| 上次提交的更新: | 07/09/2020 |
| 最近更新发布: | 07/12/2020 |
| 实际学习开始日期: | 07/31/2020 |
| 预计主要完成日期: | 03/31/2022 |
| 预计完成日期: | 03/31/2023 |
状况或疾病
干预/治疗
Device: High pressure _ low pressure non-invasive ventilation
相
手臂组
| 臂 | 干预/治疗 |
|---|---|
| High pressure _ low pressure non-invasive ventilation In the high-pressure NIV,52 patients will undergo pressure-limited NPPV at a higher IPAP level. IPAP is initially set at 20 cmH2O and continuously adjusted by increments and decrements of 1-2 cmH2O (up to 30 cmH2O), according to patients' tolerance, to obtain a tidal volume (VT) of 15 mL/kg of IBW.
2- EPAP for patients with COPD will be started at EPAP 5 and will be increased till 7 and for the patients with hypoventilation syndrome will be increased up to EPAP 8.
3-Respiratory rate 10-12 b/min. | Device: High pressure _ low pressure non-invasive ventilation Usage of High pressure non invasive ventilation in acute hypercapnic respiratory failure |
资格标准
| 有资格学习的年龄 | 18 Years 至 18 Years |
| 有资格学习的性别 | All |
| 取样方式 | Non-Probability Sample |
| 接受健康志愿者 | 是 |
| 标准 | Inclusion Criteria: All patients admitted in Assiut University Hospital and Assiut Police Hospital with acute hypercapnic respiratory failure due to COPD and Obesity hypoventilation syndrome (OHS) indicated for conventional NIV. Patients who failed on low pressure NIV will be shifted to high pressure NIV with any of these conditions: 1. PH <7.30 or less than admission level. 2. RR > 35b/m or more than admission level. 3. SpO2 < 88%. Exclusion criteria: (4) 1. Age <18 years. 2. Excessive amount of respiratory secretions or weak cough. 3. Upper airway obstruction. 4. Recent oral, facial or cranial trauma or surgery. 5. Sever abdominal distension. 6. Active upper gastrointestinal bleeding. 7. Cardiac or respiratory arrest. 8. PH<7.25. 9. Arterial oxygen tension /fraction of inspired oxygen (PaO2 / FiO2) <150mmHg. |
结果
主要结果指标
1. High pressure non invasive ventilation in acute hypercapnic respiratory failure [Patients will assessed after 2 hours from increasing pressure]
2. High pressure non invasive ventilation in acute hypercapnic respiratory failure [Patients will assessed after 2 hours from increasing pressure]
