Résumé :
|
Introduction : The aim of this paper is to describe the specific problems during sleep, especially at night, in patients admitted for exacerbation of COPD and undergoing non-invasive ventilation (NIV) in conventional plant. Material and Methods : Type of study : retrospective analysis. Subjects : patients with COPD (FEV1/FVC <70%) admitted due to worsening in hypercapnic conventional underwent NIV. Field : 2nd level hospital (reference population 340,458 inhabitants). Period of study : sample from2003 to 2008, including income from a full year (July 07 to August 08). Variables : demographic data, FEV1, type NIV, pressure applied, data gasométricos place implementation problems reflected in the evolution of night-shift nurses and medical day and annual mortality. Results : We analyzed 60 admissions (49 patients) and 366 nights. Mean age 68 ± 10 years (90%? 10%?). FEV1 (%) 38 ± 13%. 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 : The problems identified during the night to plant pneumology worsened in patients with COPD undergoing NIV are mild-moderate and infrequent. Mortality detected is low and similar to that described by other groups. The results show that implementation of NIV in COPD exacerbated initiated and continued in the emergency plan is accompanied by low morbidity and mortality night.
|