Noninvasive ventilation reduced need for intubation in elderly patients with acute hypercapnic respiratory failure

AbstractNoninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory efficiency and reducing the work of breathing in patients with severe chronic obstructive pulmonary disease. Early studies indicate that some patients with acute hypercapnic respiratory failure can be managed with high-flow nasal therapy, but more information is needed before specific recommendations for this therapy can be made. Therefore, high-flow nasal therapy use should be individualized in each particular situation and institution, taking into account resources, and local and personal experience with all respiratory support therapies.

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Comment on “Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study”

Canadian Respiratory Journal ◽

10.1155/2019/5490510 ◽

2019 ◽

Vol 2019 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Habib Md. Reazaul Karim ◽

Antonio M. Esquinas

Keyword(s):

Respiratory Failure ◽

Observational Study ◽

Noninvasive Ventilation ◽

Real Life ◽

Copd Exacerbation ◽

Hypercapnic Respiratory Failure ◽

Ventilation Weaning ◽

Acute Hypercapnic Respiratory Failure

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Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

Case Reports in Internal Medicine ◽

10.5430/crim.v4n2p31 ◽

2017 ◽

Vol 4 (2) ◽

pp. 31

Author(s):

Leonidas Grigorakos ◽

Katerina Tzortzopoulou ◽

Anastasia Alexopoulou ◽

Eva Sotiriou ◽

Dimitra Markopoulou ◽

...

Keyword(s):

Respiratory Failure ◽

Elderly Patients ◽

Lumbar Puncture ◽

Case Reports ◽

Rare Complication ◽

Antiviral Treatment ◽

Proper Treatment ◽

Hypercapnic Respiratory Failure ◽

Arterial Blood ◽

Acute Hypercapnic Respiratory Failure

Background: Differentiated diagnosis of meningoencephalitis in elderly patients, when an uncommon picture of respiratory infection leading to acute hypercapnic respiratory failure (AHRF) and without neurological signs is present, may raise serious difficulties.Case report: Two patients aged 72 (patient 1) and 75 (patient 2), without any medical history of respiratory problems, were hospitalized during spring with influenza symptoms. Within less than 24 hours from their admission, patients developed AHFR, which led to disturbances of arterial blood gases (ABGs). They were intubated and transferred, mechanically ventilated, to our intensive care unit (ICU). After normalization of ABGs, a weaning process followed. Weaning was unsuccessful, as unexpected neurological semiotics occurred. The imaging of neurological MRI revealed no special damage apart from microangiopathy. Further investigations through lumbar puncture with cerebrospinal fluid (CSF) testing revealed meningoencephalitis. Antiviral treatment was applied and the outcome was successful for both patients.Conclusion: Critical care medical personnel should be aware of the event of viral meningoencephalitis in elderly patients with AHRF. Especially in the middle of influenza endemic periods, the management of elderly patients may not be appropriate, thus resulting in serious delays for a proper treatment of disease. Laboratory screening of blood and urine, as well as other body fluids, can help detect and determine brain infection. Results from these tests can help exclude other diseases that mimic meningoencephalitis. In cases of patients who are hospitalized in the ICU due to AHRF and do not exhibit neurological abnormalities from the onset of illness, lumbar puncture and check of CSF should be a routine examination. Prophylactic vaccination of high-risk groups may be of crucial importance for preventing complications in patients who develop meningoencephalitis. However, once infected with this disease, the positive outcome is highly dependent on the immediate diagnosis and proper treatment of patients in the ICU.

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