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SUCCESSFUL PREDICTION FACTORS OF AVAPS IN PATIENTS WITH THE ACUTE EXACERBATION OF CHRONIC PULMONARY OBSTRUCTIVE DISEASE (COPD) ON NON-INVASIVE MECHANICAL VENTILATION
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Abstract
Objective: to identify a successful prediction factors in patients with exacerbation of chronic obstructive pulmonary disease (COPD) who were on noninvasive mechanical ventilation by Average Volume Assured Pressure Support (AVAPS) mode. Methods: A prospective, pre & post-intervention comparison study on 40 non-invasive ventilated patients with COPD exacerbations admitted to the Emergency Department of Bach Mai Hospital from May 2019 to August 2020. The main variables such as age, sex, blood gas indices: pH, PaCO2, PaO2, HCO3, PaO2/FiO2 ratio, mechanical ventilation parameters: Vt, Vte, PIP, Leak were collected at the timelines: before AVAPS, 3 hours, 6 hours, 12 hours after AVAPS. Successful ventilation was defined as no requirement for endotracheal intubation, clinical and blood gas stability within 24 hours. Results: The study on 40 patients (mean age 70.3 ± 9.87 years; 7.5% women) showed that there were 29 (72.5%) patients with successful ventilation. In the successful group, PaCO2, HCO3, PIP, Leak levels decreased gradually, the fastest decrease was occurred from T0 to T3-6; Vt, Vte levels increased gradually (p <0.05); In the failed group PaCO2, PaO2, PIP, Vt, Vte levels increased gradually, leak level decreased gradually (p <0.05). PaCO2 with cut-off ≥ 88 mmHg (area under ROC curve, AUC = 0.8364), PIP with cut-off ≥ 17 cmH2O (AUC = 0.8871), Leak with cut-off ≥ 29 liters/min (AUC = 0.7884) provided high sensitivity, specificity, positive predictive value and negative predictive value. Conclusion: The successful prediction factors for AVAPS were PaCO2, PIP and leak at the initiation of the non-invasive ventilation for patients with the acute exacerbation of COPD.
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Keywords
Noninvasive mechanical ventilation, AVAPS, ACOPD
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