Volume 1 Supplement 1

17th International Symposium on Intensive Care and Emergency Medicine

Open Access

Weaning from mechanical ventilation in COPD patients: interest to measure, in post-extubation, the airway occlusion pressure (P0.1), in order to indicate non-invasive pressure support ventilation (NIPSV) to prevent relapse

  • G Hilbert1,
  • D Gruson1,
  • E Parrens1,
  • F Vargas1,
  • JC Favier1,
  • G Gbikpi-Benissan1 and
  • JP Cardinaud1
Critical Care19971(Suppl 1):P055

https://doi.org/10.1186/cc57

Published: 1 March 1997

Aims of the study

Methods of NIPSV are being proposed more and more for acute exacerbations of COPD (Brochard: N Engl J Med 1995, 333:817-822) and also for respiratory insufficiency observed after extubation (Meduri: Chest 1996, 109:179-193). Objective of our prospective study: to compare parameters measured just before extubation, then in post-extubation, between COPD patients who have benefitted from NIPSV (group I) to those who did not necessitate NIPSV (group II) after weaning with pressure support (PS) ventilation.

Patients and methods

Twenty-eight COPD patients completed the study. In group I (n = 10), patients had suspected ventilatory muscle fatigue after weaning from mechanical ventilation. They presented, in 72 h post-extubation, a markup of PaCO2 of at least 20% as compared to the value measured post-extubation, and a respiratory rate > 25/min. Eighteen patients entered in group II.

We measured (Ventilator = EVITA 2 - Dräger°) P0.1, respiratory rate (RR), RR/VT, PaO2, PaCO2, (i) before extubation, with PS = 6 crnH2O, then (ii) in postextubation, during a session of facial mask ventilation of 30 min, with PS = 4 cmH2O. We compared the two groups of patients using Mann-Whitney U test for quantitative variables.

Results

See table.

Conclusion

P0.1 measured in postextubation seems to be a valuable index to indicate promptly NIPSV in order to prevent relapse after weaning from mechanical ventilation, in COPD patients.

Table

 

PS = 6 cm H2O before extubation

PS = 4 cm H2O postextubation

 
 

RR

RR/VT

PaCO2

PaO2

P0.1

RR

RR/VT

PaCO2

PaO2

P0.1

 

Group I

26 ± 5

75 ± 28

6.9 ± 0.8

9.8 ± 1.2

2.5 ± 0.7

27 ± 4

71 ± 19

7.8 ± 0.8

9.5 ± 1.3

4.2 ± 0.9

 

(n = 10)

           

Group II

24 ± 5

64 ± 24

6.5 ± 1.0

9.6 ± 2.1

2.4 ± 0.9

23 ± 5

60 ± 21

7.2 ± 0.9

9.7 ± 1.6

1.8 ± 0.8

 

(n = 18)

           

P

NS

NS

NS

NS

NS

NS

NS

NS

NS

NS

P < 0.01

PaO2 - PaCO2 : kPa; P0.1 : cmH2O.

Authors’ Affiliations

(1)
Rénamination Médicale B, Hôpital Pellegrin

Copyright

© Current Science Ltd 1997

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