GIÁ TRỊ CỦA MỘT SỐ YẾU TỐ LÂM SÀNG, CẬN LÂM SÀNG TRONG TIÊN LƯỢNG NHU CẦU THỞ MÁY Ở BỆNH NHÂN ĐỢT CẤP BỆNH PHỔI TẮC NGHẼN MẠN TÍNH

Abstract

Research objective: To determine the value of some clinical and paraclinical factors in predicting the need for mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Subjects and methods: 108 patients with COPD (43 patients with mechanical ventilation and 65 patients without mechanical ventilation), admitted to the Department of Emergency Resuscitation - National Hospital 74 from January 1, 2024 to September 15, 2024, diagnosed with COPD according to the standards of the Ministry of Health (2023). Patients were examined clinically and paraclinically at the time of admission. Assess the need for mechanical ventilation according to the standards of the Ministry of Health 2023. Synthesize clinical and paraclinical factors by univariate and multivariate logistic regression methods. Research results: Overall male/female ratio: (8.8/1), mean age: 73.1 + 10.4, from 42 to 99 years old. There was no difference in age, gender, number of acute episodes, duration of illness between the 2 groups. (p>0.05). The prognostic value of the need for mechanical ventilation of the clinical and paraclinical combination when analyzed by multivariate analysis: cyanosis (OR;0.08), mean blood pressure (OR;0.92), mMRC ≥ 3 (OR;9.62), CURB-65 score (OR;3.21) had independent value in predicting the risk of mechanical ventilation in acute episodes of COPD (p<0.05). In NIV: AUCROC of CURB-65, BAP-65, PaCO2: 0.67; 0.72; 0.76 (p < 0.05), cut-off points: CURB-65 > 2 Se: 47.7%, Sp: 89.8%, PaCO2 > 56 mmHg: Se: 53.8%, Sp: 86.9%, BAP-65 > 3 Se: 38.5%, Sp: 85.4%. In IV: AUCROC of CURB-65: 0.92, BAP-65: 0.85, PaCO2: 0.86 (p < 0.05), cut-off points: BAP-65 > 3, Se: 27.3%, Sp: 100%, CURB-65 > 2, Se: 48.8%, Sp: 97.8%, PaCO2 > 69 mmHg, Se: 83.3%, Sp: 91.2%. Conclusion: The combination of cyanosis, mMRC score, mean arterial pressure, CURB -65, BAP-65, PaCO2 scores have good value in predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease.