Skip to main content

The impact of pulmonary functions on outcome of intubated patients with chronic obstructive pulmonary disease

Abstract

Background

Assessment of lung mechanics and respiratory muscle determinants is considered to be useful for adjustment of ventilator settings to minimize dynamic hyperinflation in patients with chronic obstructive pulmonary disease (COPD).

Objective

The aim of this study is to assess the impact of pulmonary functions on the outcome of mechanically ventilated COPD patients.

Patients and methods

This study was carried out in the respiratory ICU, chest department, Assiut University Hospital. A total of 47 mechanically ventilated COPD patients were recruited into the study. The patients were divided into two groups on the basis of outcomes: successful group (36 patients) and failed group (11 patients). Analyses of different lung mechanics and respiratory muscle determinants were carried out for both groups.

Results

There was no significant difference in age between both the groups. Arterial blood gases analysis showed a significantly decreased pH, PaO2, and SaO2 in the failed group and a significantly increased PaCO2 in the failed group after 1, 24, and 48 h of mechanical ventilation. Values of lung mechanics in the failed group, compared with the successful group, showed a significantly lower respiratory compliance (29.18 ± 1.47 vs. 45.92 ± 4.08 ml/cm H2O), a significantly higher respiratory resistance (24.73 ± 1.19 vs. 22.39 ± 1.10 cm H2O/L/S), and a significantly higher intrinsic positive end expiratory pressure (8.36 ± 0.67 vs. 7.58 ± 0.94 cm H2O). Values of respiratory muscle determinants in the failed group showed a significantly lower negative inspiratory force (−17.18 ± 2.82 vs. −26.44 ± 3.32 cm H2O), a significantly lower vital capacity (382.27 ± 102.75 vs. 810.00 ± 133.03 ml), and a significantly higher occlusion pressure P0.1 (6.09 ± 1.04 vs. 1.72 ± 0.66 cm H2O).

Conclusion

Pulmonary functions in mechanically ventilated COPD patients including lung mechanics and respiratory muscle determinants had an important impact on outcome. A significant decrease in respiratory compliance, negative inspiratory force, and vital capacity with a significant increase in respiratory resistance, intrinsic positive end expiratory pressure, and occlusion pressure P0.1 was observed in the COPD group with failed extubation.

References

  1. Barnes PJ. Chronic obstructive pulmonary disease: a growing but neglected epidemic. Plos M ed 2007; 4:e112.

    Article  Google Scholar 

  2. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370:765–773.

    Article  Google Scholar 

  3. Celli BR, Mac NW, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23:932–946.

    Article  CAS  Google Scholar 

  4. Willemse B, Postma D, Timens W, et al. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperres-ponsiveness and inflammation. Eur Respir J 2004; 23:464–476.

    Article  CAS  Google Scholar 

  5. Govender N, Lalloo U, Naidoo RN. Occupational exposures and chronic obstructive pulmonary disease: a hospital based case control study. Thorax 2011; 66:597–601.

    Article  Google Scholar 

  6. Singh D, Fox S, Singer R, et al. Induced sputum genes associated with spirometric and radiological disease severity in COPD ex-smokers. Thorax 2011; 66:489–495.

    Article  Google Scholar 

  7. Ranieri VM, Giuliani R, Mascia L. Chest wall and lung contribution to the elastic properties of the respiratory system in patients with chronic obstructive pulmonary disease. Eur Respir J 1996; 9:1232–1239.

    Article  CAS  Google Scholar 

  8. Rossi A, Polese G, Brandi G, et al. Intrinsic positive end expiratory pressure (PEEPi). Intensive Care Med 1995;21:522–536.

    Article  CAS  Google Scholar 

  9. Brochard L. Intrinsic (or auto-) positive end expiratory pressure during spontaneous or assisted ventilation. Intensive Care Med 2002; 28:1552–1554.

    Article  Google Scholar 

  10. Macintyre NR. Evidence based guidelines for weaning and discontinuing ventilatory support. Chest 2001; 120:375–396.

    Article  Google Scholar 

  11. Pilbeam SP. Basic terms and concepts of mechanical ventilation. In: Pilbeam SP, Cairo JM, (eds) Mechanical ventilation physiological and clinical applications. Missouri: Mosby; 2006. 15–30.

    Google Scholar 

  12. Gea J, Alvar A, Josep R. Pathophysiology of muscle dysfunction in COPD. J Appl Physiol 2013; 114:1222–1234.

    Article  CAS  Google Scholar 

  13. Robriquet L, Hugues G, Olivier L, Patrick D, Thibaut D, Benoit G. Predictors of extubation failure in patients with chronic obstructivepulmonary disease. J Crit Care 2006; 21:185–190.

    Article  Google Scholar 

  14. Bakr R, Osama F, Ahmed A, et al. Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults. Egypt J Chest Dis Tuberc 2012; 61:67–73.

    Article  Google Scholar 

  15. Ucgun M, Metintas H, Moral F, et al. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med 2006; 100:66–74.

    Article  Google Scholar 

  16. Park J, Koh Y. Is hypercapnea a predictor of better survival in the patients who underwent mechanical ventilation for chronic obstructive pulmonary disease (COPD). Korean J Intern Me d 2006; 21:1–9.

    Article  Google Scholar 

  17. Madkour AM, Adly NN. Predictors of in hospital mortality and need for invasive mechanical ventilation in elderly COPD patients presenting with acute hypercapnic respiratory failure. Egypt J Chest Dis Tuberc 2013; 62:393–400.

    Article  Google Scholar 

  18. Jubran A, Tobin M. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 1997; 155:906–915.

    Article  CAS  Google Scholar 

  19. Lin MC, Huang CC, Yang CT, Tsai YH, et al. Pulmonary mechanics in patients with prolonged mechanical ventilation. Anaesth Intensive Care 1999; 27:581–585.

    Article  CAS  Google Scholar 

  20. Nava S, Rubini F, Zanotti E, Ambrosino N, et al. Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation. Eur Respir J 1998; 7:1645–1652.

    Article  Google Scholar 

  21. Broseghini C, Brandolese R, Poggi R, et al. Respiratory mechanics during first day of mechanical ventilation. Acta Anaesthesiol Scand 2006; 50:80–91.

    Article  Google Scholar 

  22. West JB. Mechanics of breathing. Respiratory physiology, the essentials. 6th ed. Philadelphia: Lippincott; 2000. 79–102.

    Google Scholar 

  23. Blanch L, Bernabe F, Lucangelo U. Measurement of air trapping, intrinsic positive end expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients. Respir Care 2005; 50:110–123.

    PubMed  Google Scholar 

  24. Graham C, Nausherwan K. The relationship of resting ventilation to mouth occlusion pressure, an index of resting pulmonary function. Chest 1999; 98:900–906.

    Google Scholar 

  25. Li Y, He G, Chen R. Clinical study of weaning predictors in COPD patients with prolonged mechanical ventilation. Zhonghua Jie He He Hu Xi Za Zhi 2000; 23:217–220.

    CAS  PubMed  Google Scholar 

  26. Prigent H, David O, Nadège L, et al. Vital capacity versus maximal inspiratory pressure in patients with Guillain–Barré syndrome and myasthenia gravis. Neurocrit Care 2012; 17:236–239.

    Article  Google Scholar 

  27. Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain–Barré syndrome. Arch Neurol 2001; 58:893–898.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khaled Hussein.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Metwally, A., Hussein, K., El-Abdeen, A.Z. et al. The impact of pulmonary functions on outcome of intubated patients with chronic obstructive pulmonary disease. Egypt J Bronchol 9, 125–132 (2015). https://doi.org/10.4103/1687-8426.158041

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.158041

Keywords

  • intrinsic positive end expiratory pressure
  • lung mechanics
  • respiratory muscle determinants