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2011, Number 4

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Med Crit 2011; 25 (4)

Posthypercapnic alcalosis in exacerbated chronic obstructive pulmonary disease

Salinas MC, Magaña MC, Santiago TJ, Olvera GC, Aguirre SJ, Franco GJ

Language: Spanish
References: 20
Page: 218-225
PDF size: 99.41 Kb.


ABSTRACT

Introduction: Alkalosis post hipercapnia is a complication (APH) is a frequent complication of mechanical ventilation (MV) in exacerbated COPD.
Methods: Retrospective study of 232 files with exacerbated COPD; 30 were selected because they used MV but 10 were exclude as it was non invasive.
Results: Mean age: 74 ± 11 years, mean APACHE II score: 18 ± 7 (8-38), 13 male (65%); 16 survived, mortality: 20%. We divided them in patients without APH (n = 11, 55%) and with APH (n = 9, 45%). CO2 previous to MV: 70 ± 27 (31-114) and 87 ± 11 (68-99) in patients without APH and with APH respectively. (p = 0.09), day 1: 44 ± 6 (30-50) and 61 ± 19 (35-89) with p = 0.01, day 3 and 6 without difference. HCO3: significant values were on day 1, 3 and 6: day 1, 26 ± 3.9 vs 37 ± 7, p = 0.0001, day 3: 27 ± 4 vs 38 ± 5.5, p = 0.0001 and day 6: 30 ± 5 vs 41 ± 6, p = 0.0001. Mortality: 18.2% and 22.2% with APH and without APH respectively, without difference. Length of stay was 16 ± 4 vs 26 ± 15 and p = 0.04.
Conclusions: Patients with COPD and APH have longer length of stay and days under MV. There is a continuous elevation of bicarbonate, without relation to PaCO2 changes, gastrointestinal looses or administration of HCO3.


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