Invasive Ventilation Risk in COPD Exacerbation

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Alcohol abuse, fluid and electrolyte abnormalities, and pulmonary circulation disorders increased the risk for noninvasive ventilation in a COPD exacerbation.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are at a higher risk of needing invasive ventilation if alcohol abuse, abnormalities with fluid and electrolyte balance, and pulmonary circulation disorders are present, according to a retrospective study presented at the CHEST Annual Meeting October 6 through October10, 2018 in San Antonio, Texas.

Researchers analyzed patients (N=73,480; mean age, 67.8 years) diagnosed with an exacerbation of COPD from the Nationwide Inpatient Sample databases between 2012 and 2014. These patients were treated with noninvasive, bilevel positive airway pressure ventilation for the first 24 hours, and then monitored for intubation for the next 30 days. All comorbidities were based on ICD-9 codes recorded.

The Cox proportional hazard models indicated a significant relationship between needing invasive ventilation and alcohol abuse (hazard ratio [HR] 1.85; 95% CI, 1.15-2.98; P =.01), fluid and electrolyte abnormalities, such as acid-base disorders, hypervolemia, and hypovolemia (HR 1.30; 95% CI, 1.13-1.52; P<.001), and pulmonary circulation disorders, such as right ventricular dysfunction and pulmonary hypertension (HR 4.19; 95% CI, 2.78-6.32; P<.001).

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The researchers concluded that during treatment risk assessment, “these underlying conditions should be monitored closely, especially individuals with existing pulmonary circulation disorders as they are at the highest risk.”

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Pan D, Vazquez de Lara F, Santibanez V, Pondaiah S, Mathew J. Factors associated with need for invasive ventilation in patients with COPD exacerbation initially treated with noninvasive ventilation. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio TX.