Chronic obstructive pulmonary disease respiratory failure

The data for failure rates of cardiovascular (CV) drugs are similar to those for CNS, whereas for drugs against respiratory disease, such as asthma and chronic obstructive pulmonary disease (COPD), failure is shared 50 50 between safety and efficacy. 

DIAGNOSIS OF ACUTE RESPIRATORY FAILURE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ... 

Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease, edited by J.-P. Derenne, W. A. Whitelaw,... 

The safety of perflenapent has been evaluated in multicenter phase II studies in 146 patients with congestive heart failure (NYHA class III or IV, mean age 68 years), of whom 99 received perflenapent and 47 received isotonic saline, and in 134 patients with severe chronic obstructive pulmonary disease (FEVi no more than 60% of predicted, mean age 65 years), of whom 91 received perflenapent and 43 received isotonic saline (13). Blood pressure, heart rate, respiratory rate, oxygen saturation, the electrocardiogram, FEVi, complete serum biochemistry, hematology, and mental state were assessed. Adverse events were mild and required no treatment. There was no significant difference in the incidence of adverse reactions between those given perflenapent (15%) and those given placebo (11%). The most frequent adverse events with perflenapent were vasodilatation (n = 8), taste disturbance (n = 6), nausea (n = 5), and headache (n = 3). 

Lightowler JV, Wedzicha JA, Elhott MW, et al. Noninvasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease Cochrane systemic review and meta-analysis. Br Med J 2003 326 185-189. 

Doxapram is an analeptic that increases the depth of respirations (tidal volume) by stimulating the respiratory center in CNS respiratory rate may increase slightly. It may elevate BP by increasing cardiac output. Respiratory depression from opiates is reversed without affecting pain relief. It is indicated when one requires the stimulation of deep breathing in postoperative patients for reversal of respiratory depression caused by anesthesia (other than muscle relaxants) or drug overdose and as a temporary measure in acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) who are not undergoing mechanical ventilation. 

Respiratory Sensation, edited by L. Adams and A. Guz Pulmonary Rehabilitation, edited by A. P. Fishman Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease, edited by J.-P. Derenne, W. A. Whiteiaw, and T. Simiiowski Environmental Impact on the Airways From Injury to Repair, edited by J. Chretien and D. Dusser... 

Respiratory Possible unwanted effects of carvedilol, metoprolol, and bisoprolol on respiratory function in patients with heart failure and concomitant chronic obstructive pulmonary disease (COPD) have not been clearly defined. In a randomized, open, triple-crossover trial, 51 patients with heart failure, 35 of whom had also COPD, took carvedilol, metoprolol, and bisoprolol, dose-matched, each for 6 weeks before resuming their original beta-blocker. N-terminal brain natriuretic peptide (BNP)... 

Almitrine bismesylate is indicated in patients with respiratory failure with hypoxaemia related to obstructive bronchitis. It was first marketed in France in 1982 for the treatment of chronic obstructive pulmonary disease (COPD), where the airways and air sacks inside the Itmgs become damaged or blocked. Between September 2003 and November 2012, almitrine s safety was xmder increased scrutiny due to increased reports of weight loss and peripheral neuropathy despite France s regulatory actions to minimise the risk of these AR by dose adjustments and increased warnings. 

Abbreviations. MV, mechanical ventilation AECOPD, acute exacerbation of chronic obstructive pulmonary disease ALD, acute lung disease ALI, acute lung injury ARDS, acute respiratory distress syndrome CLD, chronic lung disease COPD, chronic obstructive pulmonary disease MOF, multiple organ failure NMD, neuromuscular disease NR, not reported. 

Figure 5 Transdiaphragmatic twitch pressure recorded in mechanically ventilated patients recovering from an episode of acute respiratory failure. Box represents range of transdiaphragmatic twitch pressures recorded in ambulatory patients with severe COPD. Most mechanically ventilated patients had evidence of diaphragmatic weakness [data from Ref. 62 (open circles), and from Ref 61 (closed circles)]. Abbreviation COPD, chronic obstructive pulmonary disease. Source From Refs. 44.

Krishan JA, Moore D, Robeson C, et al. A prospective controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 2004 169 673-678. Nava S, Amlnosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized controlled trial. Ann Intern Med 1998 128 721-728. 

Ambrosino N, Bmletti G, Scala V, et al. Cognitive and perceived health status in patient with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure a controlled study. Intensive Care Med 2002 28 170-177. 

Acute respiratory failure is the most common reason for admission to an ICU and 80% of mechanically ventilated patients resume spontaneous breathing after a few days (6). Of the remaining patients who cannot be weaned, those with chronic obstructive pulmonary disease (COPD) are often the most difficult to separate from the ventilator (7). Common obstacles to weaning include immobility and deconditioning prior to... 

Abbreviations-. TCEMS, transcutaneous electrical muscle stimulation CHF, congestive heart failure COPD, chronic obstructive pulmonary disease Vo2max, peak oxygen consumption NYHA, New York heart association CSA, cross-sectional area Wmax, maximal workload CRQ, chronic respiratory disease questionnaire. 

Sivasothy P, Smith IE, Shneerson JM. Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease. Eur Respir J 1998 ll(l) 34-40. 

NIV is often an effective treatment for patients with acute respiratory failure, especially when secondary to exacerbation of chronic obstructive pulmonary disease (COPD) (24). NIV is also utilized for long-term ventilation (LTV) of patients with chronic respiratory failure due to thoracic restriction or NMD. It is used less frequently for COPD as there is only limited evidence of its long-term effectiveness in this condition (25). In stable patients, NIV is affected by the type of interface used (26). 

The most common causes of failure to wean include chronic obstructive pulmonary disease (COPD) exacerbations, neuromuscular diseases, h) oxic respiratory failure, post surgical complications (2), and heart failure. Weaning from the tracheostomy must consider the balance of respiratory muscle function and work of breathing. The work of breathing is determined by ventilatory demand, compliance of the lungs and chest wall, airway resistance, and intrinsic positive end-expiratory pressure (PEEPi). Adequacy of ventilatory drive and neuromechanical output can be assessed from the respiratory rate, airway occlusion pressure at 100 milliseconds (Po.i), maximum inspiratory pressure (MIP), and maximum voluntary ventilation (MW). 

Schols AM, Slangen J, Volovics L, et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998 157 1791-1797. Sivasothy P, Smith IE, Shneerson JM. Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease. Eur Respir J 1998 11 34-40. 

Chronic ventilatory support is currently a well-accepted therapy in patients with chronic respiratory failure due to thoracic cage abnormalities or in patients with neuromuscular disease. In contrast, the evidence to use chronic ventilatory support in patients with obstructive lung disease is less clear. Most of studies in this area have been in patients with chronic obstructive pulmonary disease (COPD) and only a few in patients wiA cystic fibrosis (CF) and bronchiectasis. In this chapter, we will focus primarily on COPD, discussing first the rationale of noninvasive positive pressure ventilation (NIPPV) in these patients and second all randomized controlled studies. Thereafter, we will elaborate on different issues that might be important in making NIPPV more effective in patients with COPD. Finally, we will discuss the effeets of ehronie ventilatory support in patients with CF and bronchiectasis. 

A 53-year-old woman with severe chronic obstructive pulmonary disease, on home oxygen, had been admitted to the ICU on three occasions in 2003, for acute respiratory failure consequent upon an acute exacerbation, always unresponsive with a Glasgow Coma Scale 8/15 (Table 9). She received noninvasive positive pressure ventilation (NIPPV) by mask on each admission and after 24 hours had greatly improved. On each occasion, her LOS was 17 days before discharge home, representing acute care cost of 8880 (seven days ICU = 6300 plus 10 days ward = 2580, for a total of 8880 per admission). 

Figure 1 The management of respiratory failure in the United States. Many patients are admitted initially to an acute care hospital. If they wean ptomptiy, they may spend time in an LTAC hospital for rehabilitation, and eventually return home. If they fail to wean, they undergo tracheostomy and are transferred to an LTAC when stable. Weaning attempts continue, and a mincnity of patients return home the rest remain at the LTAC or are transferred to a SNF. Patients who deteriorate while at LTACs or at home return to the acute care hospital fOT stabilization. Some patients with chronic respiratory failure do not require acute care but are ventilated noninvasively and remain home. Abbreviations COPD, chronic obstructive pulmonary disease NIV, noninvasive ventilation LTAC, long-term acute care SNF, skilled nursing facility.

Oxygen Increased arterial O2 content, potentiates activity of other antidotes Inhalation via mask or endotracheal tube (BIT) High flow via mask or 100 % via ETT Intermittent positive pressure ventilation if respiratory failure and arrest No more than 24 h Unlikely—possible in patients with chronic obstructive pulmonary disease (COPD)... 

---