Acid-base balance, serum electrolytes and need for non-invasive ventilation in patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease admitted to an internal medicine ward.

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2016-05-25 eCollection Date: 2016-01-01 DOI:10.1186/s40248-016-0063-2
Alfonso Schiavo, Maurizio Renis, Mario Polverino, Arcangelo Iannuzzi, Francesca Polverino
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引用次数: 10

Abstract

Background: Hypoventilation produces or worsens respiratory acidosis in patients with hypercapnia due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In these patients acid-base and hydroelectrolite balance are closely related. Aim of the present study was to evaluate acid-base and hydroelectrolite alterations in these subjects and the effect of non-invasive ventilation and pharmacological treatment.

Methods: We retrospectively analysed 110 patients consecutively admitted to the Internal Medicine ward of Cava de' Tirreni Hospital for acute exacerbation of hypercapnic chronic obstructive pulmonary disease. On admission all patients received oxygen with a Venturi mask to maintain arterial oxygen saturation at least >90 %, and received appropriate pharmacological treatment. Non-Invasive Ventilation (NIV) was started when, despite optimal therapy, patients had severe dyspnea, increased work of breathing and respiratory acidosis. Based on Arterial Blood Gas (ABG) data, we divided the 110 patients in 3 groups: A = 51 patients with compensated respiratory acidosis; B = 36 patients with respiratory acidosis + metabolic alkalosis; and C = 23 patients with respiratory acidosis + metabolic acidosis. 55 patients received only conventional therapy and 55 had conventional therapy plus NIV.

Results: The use of NIV support was lower in the patients belonging to group B than in those belonging to group A and C (25 %, vs 47 % and 96 % respectively; p < 0.01). A statistically significant association was found between pCO2 values and serum chloride concentrations both in the entire cohort and in the three separate groups.

Conclusions: Our study shows that in hypercapnic respiratory acidosis due to AECOPD, differently from previous studies, the metabolic alkalosis is not a negative prognostic factor neither determines greater NIV support need, whereas the metabolic acidosis in addition to respiratory acidosis is an unfavourable element, since it determines an increased need of NIV and invasive mechanical ventilation support.

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内科病房收治慢性阻塞性肺疾病急性加重期高碳酸血症患者的酸碱平衡、血清电解质和无创通气需求
背景:慢性阻塞性肺疾病(AECOPD)急性加重所致高碳酸血症患者低通气可导致或加重呼吸性酸中毒。在这些患者中,酸碱和电解质平衡密切相关。本研究的目的是评估这些受试者的酸碱和电解质变化以及无创通气和药物治疗的效果。方法:回顾性分析Cava de' Tirreni医院内科病房连续收治的110例慢性阻塞性肺疾病急性加重期高碳酸血症患者。入院时,所有患者均接受文丘里面罩供氧以维持动脉血氧饱和度至少> 90%,并接受适当的药物治疗。无创通气(NIV)开始时,尽管最佳治疗,患者有严重的呼吸困难,呼吸功增加和呼吸性酸中毒。根据动脉血气(ABG)数据,我们将110例患者分为3组:A = 51例代偿性呼吸性酸中毒;B =呼吸性酸中毒+代谢性碱中毒36例;C = 23例呼吸性酸中毒+代谢性酸中毒。55例患者仅接受常规治疗,55例患者接受常规治疗加NIV。结果:B组患者使用NIV支持的比例低于A组和C组(25%,分别为47%和96%;p结论:我们的研究表明,在AECOPD引起的高碳酸血症性呼吸性酸中毒中,与以往的研究不同,代谢性碱中毒不是一个负面的预后因素,也不决定更大的NIV支持需求,而代谢性酸中毒除了呼吸性酸中毒之外是一个不利的因素,因为它决定了对NIV和有创机械通气支持的需求增加。
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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
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发文量
23
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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