Résumé :
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Introduction : The aim of this paper is to describe how we use NIMV in the Costa del Sol Hospital in patients admitted for exacerbation of COPD Material and Methods : Study type : descriptive. Subjects : patients with COPD (FEV1/FVC <70%) admitted due to worsening under hypercapnic NIV. Field : 2nd level hospital (reference population 340,458 inhabitants). Period of study : sample from 2003 to 2008, including income from a full year (July 07 to August 08). Variables : demographic data, FEV1, type NIV, pressure applied gasométricos data, location and implementation of action NIV mortality anual. Protocolo in the Costa del Sol Hospital Results : We analyzed 60 admissions (49 patients) and 366 nights. Mean age 68 ± 10 years (90%? 10%?). NIV Type : BIPAP (100%). Pressures : inspiratory 13.5 ± 2 (9-18), expiratory 5 ± 1 (3-8). NIV Home : Emergency 68%, 30% plant, UCI 2%. Ph comprehensive baseline at the start : 7.26 ± 0.08 (baseline pH 7.25 ± 0.08 in the emergency room, basement floor pH 7.28 ± 0.07). Ph plant after admission to stabilize : 7.33 ± 0.05. Service revenue : 98% pulmonology, internal 2%. No. nights in plant NIV : 6 ± 3 (1-18). NIV compliance Night : 63% complete, partial 20%, 17% did not use. Evening problems : poor adaptation to mask intolerance or excessive pressure 32%, agitation 2.1%(n = 8), dyspnea increased 1.6%(n = 6), insomnia 1.6% (n = 6), headache 0.8% (n = 3 ), anxiety 0.5% (n = 2), damage NIV 0.5% (n = 2), lack connection NIV 0.2% (n = 1). 14 warnings were detected to the doctor on duty (3.8%nights), reasons : poor tolerance NIV 1.6%(n = 6), parameter mismatch 0.5% (n = 2), agitation 1.3% (n = 5), damage BIPAP 0.5 % (n = 2), insomnia 0.2% (n = 1), dyspnea 0.2% (n = 1), headache 0.2% (n = 1). For the full year of follow-up (n = 32) were 3 death (mortality 9.3%). Conclusions : A proper training in the art NIVM from nursing reduces the problems of adaptation to the device (intoleracia mask, excessive pressure) The ongoing monitoring by the sleep nurse as well as the nurse of the service allows early detection of potential technical failures. The results show that implementation of NIMV in COPD exacerbated initiated and continued in the emergency plan is accompanied by low morbidity and mortality.
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