CÁC YẾU TỐ TIÊN LƯỢNG CAI MÁY THÀNH CÔNG CỦA PHƯƠNG THỨC THÔNG KHÍ THÍCH ỨNG Ở BỆNH NHÂN ĐỢT CẤP BỆNH PHỔI TẮC NGHẼN MẠN TÍNH

Abstract

Objective: To identity predictive factors for successful weaning by the adaptive ventilation mode (AVM) on patients with the exacerbation of chronic obstructive pulmonary disease (COPD). Methods: A prospective study was carried out, on 25 invasive ventilated patients with COPD exacerbations admitted to the Emergency Department of Bach Mai Hospital from September 2020 to August 2021. The main variables such as age, sex, blood gas indices: pH, PaCO2, PaO2, HCO3, PaO2/FiO2 ratio, lactate , vital signs parameters: heart rate , blood pressure, respiratory rate, SpO2 were collected at the timelines: admission, 30 minutes, 60 minutes, 120 minutes after AVM, before extubation and after extubation. Patients were considered successfully weaned if they were not be re-intubated after 48 hours. Results: Among 25 patients (mean age 74.04 ± 9.92 years; 8% women), there were 21 (84%) patients with successful tracheal extubation. On admission, the successful group had SOFA score (4.82±2.1) and APACHE II score (16.24±4.44), lower than that of the failure group 9±1.92, 21.2±2.99, respectively with p < 0.05. The heart rate, respiratory rate, pH, PaCO2, lactate of the successful group was stable during weaning meanwhile the heart rate, respiratory rate gradually increased, pH gradually decreased in the 60 minutes after weaning, the most significant difference was before extubation or before switching back to continuous mandatory ventilation with p < 0,05. Conclusion: APACHE II, SOFA scores on admission are able to predict the successful extubation. Monitoring the heart rate, respiratory rate, pH, PaCO2, lactate can also predict for successful weaning by adaptive ventilation mode (AVM) in patients with acute exacerbations of COPD.