Author/Authors :
Faverio, Paola School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Stainer, Anna School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , De Giacomi, Federica School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Messinesi, Grazia School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Paolini, Valentina School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Monzani, Anna School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Sioli, Paolo School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Memaj, Irdi School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Sibila, Oriol Respiratory Department - Hospital de La Santa Creu I Sant Pau - Autonomous University of Barcelona and Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain , Mazzola, Paolo School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy , Pesci, Alberto School of Medicine and Surgery - University of Milan Bicocca - San Gerardo Hospital, Monza, Italy
Abstract :
(e most recent British (oracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV)
in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering.
However, a limited number of studies evaluated the phase of NIV weaning. (e aim of this study is to describe the NIV weaning
protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients’ characteristics,
clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study
on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis
of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the
three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who
started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and
were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary
ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group).
Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic
NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who
completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described,
our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a
weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients.
