• Franciele Plachi, Fernando Nataniel Vieira, Danilo Cortozi Berton, Marli Knorst, Alexandre Simões Dias, and Fernanda Machado Balzan.
• Physical Therapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Pneumology Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
• Rev Bras Fisioter. 2017 Sep 1; 21 (5): 357-364.

ObjectivesTo investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a "real-life" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation.MethodsRetrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation).Results117 consecutive chronic obstructive pulmonary disease exacerbation admissions (Group A=96; Group B=13; Group C=8) of candidates for ventilatory support were reviewed. No differences in baseline disease severity and physiological parameters were found between the groups at Emergency Department admission. Nevertheless, Group B had higher intensive care unit admission, length of hospital stay, length of intensive care unit stay, and higher in-hospital mortality compared to Group A. Group C also had worse outcomes when compared to Group A. The only independent variable associated with the successful use of noninvasive positive pressure ventilation were improvement in arterial carbon dioxide pressure after 1h of noninvasive positive pressure ventilation use and its tolerance.ConclusionOur data confirmed in a "real life" Emergency Department cohort that successful management of chronic obstructive pulmonary disease exacerbation with noninvasive positive pressure ventilation showed lower in-hospital mortality and Intensive Care Unit stay when compared to patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation or patients who presented an immediate need for invasive mechanical ventilation. noninvasive positive pressure ventilation tolerance and higher arterial carbon dioxide pressure reduction after 1-h of noninvasive positive pressure ventilation were predictors of successful treatment. These results should be confirmed in a prospective randomized controlled trial.Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

23 keywords...

hide…