Original Articles
Evolution of Patients With Chronic Obstructive Pulmonary Disease, Obesity Hypoventilation Syndrome, or Congestive Heart Failure Undergoing Noninvasive Ventilation in a Respiratory Monitoring Unit
Ángel Ortega González, Germán Peces-Barba Romero
, Itziar Fernández Ormaechea, René Chumbi Flores, Noelia Cubero de Frutos, Nicolás González Mangado
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gpecesba@fjd.es
Correspondence: Dr. G. Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España
Correspondence: Dr. G. Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España
Servicio de Neumología, Fundación Jiménez Díaz, Madrid, Spain
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Soriano, José Luis Izquierdo Alonso" "autores" => array:2 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "Joan B." 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Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-08-29" "fechaAceptado" => "2006-02-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154522" "palabras" => array:7 [ 0 => "Noninvasive ventilation" 1 => "Respiratory insufficiency" 2 => "Chronic obstructive pulmonary disease" 3 => "Obesity hypoventilation syndrome" 4 => "Heart failure, congestive" 5 => "Acidosis: respiratory" 6 => "Respiratory Monitoring Unit" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154523" "palabras" => array:7 [ 0 => "Ventilación no invasiva (VNI)" 1 => "Insuficiencia respiratoria aguda" 2 => "Enfermedad pulmonar obstructiva crónica (EPOC)" 3 => "Síndrome de hipoventilación-obesidad (SHO)" 4 => "Insuficiencia cardíaca congestiva" 5 => "Acidosis hipoxémica-hipercápnica" 6 => "Unidad de monitorización respiratoria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">We compared the use of noninvasive ventilation (NIV) for hypercanic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic group's response to therapy in terms of clinical course and evolution of blood gases.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Prospective, 12-month study of 53 patients with hypercanic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1–3 hours and 12–24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO<span class="elsevierStyleInf">2</span> worsened for COPD patients (<span class="elsevierStyleItalic">P</span>=.026) and PaO<span class="elsevierStyleInf">2</span> improved for CHF patients (<span class="elsevierStyleItalic">P</span>=.028). After 1 to 3 hours of NIV, pH (<span class="elsevierStyleItalic">P</span>=.002) and PaO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">P</span>=.041) improved for COPD patients, and pH (<span class="elsevierStyleItalic">P</span>=.03) and PaCO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">P</span>=.045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, <span class="elsevierStyleItalic">P</span>=.076).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Hemos realizado un trabajo comparativo en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), síndrome de hipoventilación-obesidad (SHO) e insuficiencia cardíaca congestiva (ICC) sometidos a ventilación no invasiva (VNI) en una unidad de monitorización de neumología por presentar acidosis hipoxémica-hipercápnica. El objetivo ha sido valorar la respuesta clínica y gasométrica en función del diagnóstico.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio prospectivo (12 meses de duración) en 53 pacientes con acidosis hipoxémica-hipercápnica, de los que 27 presentaban EPOC; 17, SHO, y 9, ICC. Realizamos un análisis de la gravedad gasométrica inicial, de la evolución gasométrica (tras tratamiento convencional y tras VNI a las 1–3 h y 12–24 h) y de la mortalidad. Todos ellos recibieron VNI tipo BiPAP en modo asistido-controlado.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La presentación gasométrica inicial era similar en las 3 entidades (valores medios ± desviación estándar de pH, 7,28 ± 0,1 en la EPOC; 7,29 ± 0,09 en SHO, y 7,24 ± 0,07 en ICC; no significativo). Tras tratamiento convencional inicial, en los pacientes con EPOC se observó un empeoramiento de la presión arterial de anhídrido carbónico (p = 0,026), y en aquellos con ICC, una mejoría de la presión arterial de oxígeno (p = 0,028). Tras el inicio de la VNI (1–3 h) se produjo una mejoría del pH (p = 0,002) y de la presión arterial de oxígeno (p = 0,041) en la EPOC, y del pH (p = 0,03) y de la presión arterial de anhídrido carbónico (p = 0,045) en el SHO; no hubo cambios significativos en la ICC. Tras 12–24 h con VNI, el pH fue de 7,36 ± 0,04 en la EPOC, de 7,36 ± 0,05 en el SHO y de 7,25 ± 0,1 (no significativo) en la ICC. La mortalidad fue del 11,1% en la EPOC, del 0% en el SHO y del 33,3% en la ICC (no significativo; p = 0,076).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Partiendo de una gravedad gasométrica similar, en el SHO y la EPOC se observó una mejor respuesta a la VNI que en la ICC. El inicio de la VNI suele precederse de mala respuesta al tratamiento convencional en la EPOC, lo que haría replantearse la demora para iniciarla.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive positive pressure ventilation to treat respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Meyer TJ" 1 => "Hill NS" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 26 | 20 | 46 |
| 2024 September | 28 | 10 | 38 |
| 2024 August | 35 | 40 | 75 |
| 2024 July | 29 | 37 | 66 |
| 2024 June | 29 | 25 | 54 |
| 2024 May | 31 | 33 | 64 |
| 2024 April | 14 | 37 | 51 |
| 2024 March | 17 | 20 | 37 |
| 2024 February | 16 | 20 | 36 |
| 2023 March | 2 | 3 | 5 |
| 2023 February | 9 | 17 | 26 |
| 2023 January | 14 | 22 | 36 |
| 2022 December | 15 | 20 | 35 |
| 2022 November | 19 | 19 | 38 |
| 2022 October | 19 | 31 | 50 |
| 2022 September | 11 | 13 | 24 |
| 2022 August | 18 | 34 | 52 |
| 2022 July | 15 | 41 | 56 |
| 2022 June | 13 | 27 | 40 |
| 2022 May | 12 | 22 | 34 |
| 2022 April | 17 | 33 | 50 |
| 2022 March | 17 | 26 | 43 |
| 2022 February | 16 | 26 | 42 |
| 2022 January | 10 | 34 | 44 |
| 2021 December | 16 | 44 | 60 |
| 2021 November | 16 | 54 | 70 |
| 2021 October | 12 | 49 | 61 |
| 2021 September | 19 | 59 | 78 |
| 2021 August | 13 | 26 | 39 |
| 2021 July | 21 | 27 | 48 |
| 2021 June | 20 | 38 | 58 |
| 2021 May | 11 | 23 | 34 |
| 2021 April | 31 | 45 | 76 |
| 2021 March | 16 | 26 | 42 |
| 2021 February | 10 | 12 | 22 |
| 2021 January | 9 | 10 | 19 |
| 2020 December | 15 | 12 | 27 |
| 2020 November | 7 | 15 | 22 |
| 2020 October | 11 | 11 | 22 |
| 2020 September | 14 | 7 | 21 |
| 2020 August | 6 | 11 | 17 |
| 2020 July | 8 | 16 | 24 |
| 2020 June | 7 | 6 | 13 |
| 2020 May | 12 | 11 | 23 |
| 2020 April | 8 | 18 | 26 |
| 2020 March | 13 | 13 | 26 |
| 2020 February | 12 | 15 | 27 |
| 2020 January | 13 | 16 | 29 |
| 2019 December | 10 | 15 | 25 |
| 2019 November | 9 | 9 | 18 |
| 2019 October | 7 | 8 | 15 |
| 2019 September | 3 | 10 | 13 |
| 2019 August | 13 | 7 | 20 |
| 2019 July | 15 | 17 | 32 |
| 2019 June | 40 | 14 | 54 |
| 2019 May | 40 | 12 | 52 |
| 2019 April | 40 | 20 | 60 |
| 2019 March | 18 | 22 | 40 |
| 2019 February | 8 | 10 | 18 |
| 2019 January | 4 | 13 | 17 |
| 2018 December | 7 | 10 | 17 |
| 2018 November | 10 | 10 | 20 |
| 2018 October | 14 | 9 | 23 |
| 2018 September | 8 | 8 | 16 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 5 | 3 | 8 |
| 2018 March | 5 | 2 | 7 |
| 2018 February | 6 | 7 | 13 |
| 2018 January | 5 | 9 | 14 |
| 2017 December | 4 | 5 | 9 |
| 2017 November | 4 | 6 | 10 |
| 2017 October | 4 | 9 | 13 |
| 2017 September | 3 | 9 | 12 |
| 2017 August | 6 | 11 | 17 |
| 2017 July | 2 | 3 | 5 |
| 2017 June | 5 | 15 | 20 |
| 2017 May | 6 | 9 | 15 |
| 2017 April | 4 | 6 | 10 |
| 2017 March | 1 | 3 | 4 |
| 2017 February | 1 | 1 | 2 |
| 2017 January | 1 | 3 | 4 |
| 2016 December | 7 | 11 | 18 |
| 2016 November | 16 | 14 | 30 |
| 2016 October | 24 | 16 | 40 |
| 2016 September | 11 | 6 | 17 |
| 2016 August | 10 | 3 | 13 |
| 2016 July | 10 | 0 | 10 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 52 | 8 | 60 |
| 2015 September | 49 | 10 | 59 |
| 2015 August | 51 | 7 | 58 |
| 2015 July | 38 | 5 | 43 |
| 2015 June | 42 | 5 | 47 |
| 2015 May | 56 | 14 | 70 |
| 2015 April | 51 | 12 | 63 |
| 2015 March | 39 | 12 | 51 |
| 2015 February | 57 | 11 | 68 |
| 2015 January | 32 | 11 | 43 |
| 2014 December | 56 | 8 | 64 |
| 2014 November | 49 | 12 | 61 |
| 2014 October | 51 | 9 | 60 |
| 2014 September | 48 | 13 | 61 |
| 2014 August | 45 | 9 | 54 |
| 2014 July | 57 | 7 | 64 |
| 2014 June | 78 | 11 | 89 |
| 2014 May | 70 | 12 | 82 |
| 2014 April | 54 | 7 | 61 |
| 2014 March | 73 | 8 | 81 |
| 2014 February | 64 | 14 | 78 |
| 2014 January | 44 | 7 | 51 |
| 2013 December | 44 | 10 | 54 |
| 2013 November | 47 | 12 | 59 |
| 2013 October | 65 | 8 | 73 |
| 2013 September | 40 | 10 | 50 |
| 2013 August | 40 | 6 | 46 |
| 2013 July | 56 | 14 | 70 |
| 2013 June | 48 | 5 | 53 |
| 2013 May | 50 | 2 | 52 |
| 2013 April | 34 | 4 | 38 |
| 2013 March | 10 | 1 | 11 |
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