Abstract
Patients with chronic obstructive pulmonary disease (COPD) patients are susceptible to complications, especially volutrauma, during the period of mechanical ventilation; low ventilation is a safe strategy to avoid these complications. Noninvasive capnography is a suitable technique for monitoring and assessing the cardiac and the pulmonary status of these patients during the period of mechanical ventilation. Assessment of the cardiac and the pulmonary status of two COPD patient groups receiving mechanical ventilation with a low tidal volume strategy using a noninvasive CO2 respiratory profile monitor (volumetric capnography). Forty patients were recruited in the respiratory ICU of Abbassia Chest Hospital; these patients were divided into two groups: 20 COPD patients with the predominant pathology of chronic bronchitis (CB) and 20 patients with the predominant pathology of emphysema disease, who presented with clinical and radiological evidence of chronic obstructive lung disease and were in need of mechanical ventilation. All the patients in the study were followed up three times per day until weaning; data were recorded on admission, after 24 h and before weaning using volumetric capnography. There was significant correlation between EtCO2 and arterial PCO2 during the whole period of mechanical ventilation in CB and emphysematous patients; the mean dead-space fraction was significantly higher in the emphysema group than in the CB group. There was a significant negative correlation between the mean values of Vd/Vt and the pulmonary capillary blood flow on admission and after 24 h in the emphysema group. The mean cardiac output, the mean stroke volume, and the pulmonary capillary blood flow increased significantly before extubation in the CB group, in contrast to the emphysema group in which there was an insignificant difference. Volumetric capnography could be helpful in assessing the severity of functional disturbances, and the use of more refined noninvasive parameters will be of value in managing and monitoring COPD patients during the whole period of mechanical ventilation. Egypt J Broncho 2014 8:44–50
Highlights
Invasive mechanical ventilatory support has two important considerations in respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (COPD): they are minimizing regional overdistention and managing positive endexpiratory pressure (PEEP)
Patients and methods Forty patients were recruited in the respiratory ICU of Abbassia Chest Hospital; these patients were divided into two groups: 20 COPD patients with the predominant pathology of chronic bronchitis (CB) and 20 patients with the predominant pathology of emphysema disease, who presented with clinical and radiological evidence of chronic obstructive lung disease and were in need of mechanical ventilation
There was significant correlation between EtCO2 and arterial PCO2 during the whole period of mechanical ventilation in CB and emphysematous patients; the mean dead-space fraction was significantly higher in the emphysema group than in the CB group
Summary
Invasive mechanical ventilatory support has two important considerations in respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (COPD): they are minimizing regional overdistention and managing positive endexpiratory pressure (PEEP). Overdistention injury occurs when an excessive end-inspiratory alveolar ‘stretch’ physically damages alveolar structures and produces local and systemic inflammation (ventilatorinduced lung injury). This stretch injury may be a consequence of excessive tidal volumes. The use of volumetric capnography in mechanically ventilated patients has the capability to monitor lung mechanics and cardiac and respiratory interaction noninvasively [3]. Patients with chronic obstructive pulmonary disease (COPD) patients are susceptible to complications, especially volutrauma, during the period of mechanical ventilation; low ventilation is a safe strategy to avoid these complications. Noninvasive capnography is a suitable technique for monitoring and assessing the cardiac and the pulmonary status of these patients during the period of mechanical ventilation
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