Application of non-invasive positive pressure ventilation combined with PetCO2 monitoring for patients with chronic obstructive pulmonary disease combined with severe respiratory failure

Abstract

Objective: To investigate the role of PetCO2 monitoring in non-invasive positive pressure ventilation (NPPV) treatment for chronic obstructive pulmonary disease (COPD) patients combined with severe respiratory failure. Study Design: A clinical retrospective study. Place and Duration of Study: The ICU Emergency Department, Wuxi Second People's Hospital, Wuxi, China, from February 2015 to February 2016. Methodology: A total of 60 COPD patients with respiratory failure were selected. All patients received non-invasive positive pressure ventilation and conventional treatment. PetCO2 values were recorded two hours before and after NPPV treatment. At the same time, blood was collected for arterial blood gas analysis. Changes in PetCO2, PaCO2 and the difference between PaCO2 and PetCO2 (Pa-etCO2) were also monitored to determine the correlation between PetCO2 and PaCO2. Results: After two hours of initial NPPV treatment, among the 60 patients, the PaCO2 and Pa-etCO2 of 40 patients were significantly decreased (66.7%), the PaCO2 and Pa-etCO2 of 20 patients were not significantly decreased (33.3%). The correlation analysis revealed that PaCO2 and PetCO2 were negatively correlated (correlation coefficient r = -0.537, p=0.001, p<0.001). Furthermore, there were no significant correlations between PaCO2 and PetCO2 in the ineffective group (correlation coefficient r = -0.253, p=0.116, p>0.05). Conclusion: PaCO2 monitoring could not be replaced by PetCO2 monitoring for patients with COPD combined with severe respiratory failure. Nevertheless, dynamic monitoring can instantly feedback the respiration state, which can guide the respiration, and improve the success rate of NPPV treatment and prognosis.