SEQUENTIAL NON-INVASIVE FOLLOWING SHORT-TERM INVASIVE MECHANICAL VENTILATION IN THE TREATMENT OF HYPERCAPNIC RESPIRATORY FAILURE OF ELDERLY PATIENTS WITH COPD

Objective To evaluate the feasibility and the efficacy of sequential non-invasive mechanical ventilation (MV) in the treatment of hypercapnic respiratory failure in elderly patients of COPD.Methods 26 elderly patients with severe hypercapnic respiratory failure complicated by infective exacrbations of COPD were enrolled and grouped into two groups.The sequential ventilation group received the following ventilation modality:SIMV+PSV+PEEP,and when pulmonary infections were controlled,then the ventilation modality was switched to oranasal face PSV+PEEP,followed by PSV untile the weaning.The control group received invasive ventilation modality,and weaned with SIMV+PSV.The parameters including infection,ventilation and oxygenation,ventilation duration,ventilator-associated pneumonia(VAP),duration of ICU stay were serially measured.Results Both groups had the similar baseline clinical characteristics(P 0.05 ).Between the squential group and the control,the durations of MV were (7.4±3) days vs.(22±15) days (P 0.05 ),the total duration of ventilation support (14±7) vs (2±15) days (P0.05);the incidences of VAP 0/13 vs 7/13(P0.01);the duration of ICU stay (14±7) vs (25±15) days(P0.05),respectively.Conclusions Early extubation followed by noninvasive ventilation might decrease the total duration of ventilatory support,the risks of VAP and the duration of ICU stay.