AI Summary & Key Takeaways
AI InsightIn conclusion, we think that hypercapnia may be reversible in patients admitted with hypercapneic acute COPD attack when PaCO2, SaO2 and BUN levels are high and P(A-a)O2 levels are low, and patients with PaCO2 levels higher than 60 mmHg may benefit much from medical treatment.
📌 3 Key Takeaways
Abstract
Hypercapnia is frequently encountered during acute attacks of chronic obstructive pulmonary disease (COPD), and is reversible in some cases. This study was designed to investigate the clinical and laboratory features of COPD patients admitted to hospital with acute attack of COPD and hypercapnia, whose arterial carbondioxide levels (PaCO2) were initially higher than 60 mmHg. Among 40 patients with hypercapneic acute COPD attack, the ones whose PaCO2 decreased 15% or more with medical treatment were classified as group 1 (n= 16), the other patients were classified as group 2 (n= 24). Another classification for the same patients was done as group A (PaCO2$geq$ 60 mmHg, n= 17) ve group B (PaCO2 < 60 mmHg, n= 23). Between group 1 and group 2, sex variations, smoking history, PA chest X-Ray features, presence of corpulmonale and means of ages, disease duration, pulmonary artery pressures (PAP), spirometric values, leucocyte counts, hemoglobin, hematocrit, creatinin, pH, PaO2 and HCO3- levels were not statistically significant (p> 0.05). In group 1, higher PaCO2, oxygen saturation (SaO2) and BUN levels, lower alveolo-arterial oxygen gradient P(A-a)O2 levels were found statistically significant (p< 0.05). Though not statistically significant, spirometric recovery of group 1 was found higher than group 2. In group A and group B, differences between ages, sex, disease duration, smoking history, spirometric values, leucocyte counts, hemoglobin, hematocrit, creatinin, PaO2 and HCO3- values, PA chest X-Ray features, PAP, presence of cor pulmonale were not found statistically significant (p> 0.05). In group A, lower pH and BUN levels and higher P(A-a)O2 levels were found statistically significant (p< 0.05). Mechanical ventilation was used in 4 patients in group A and 2 of them died (p< 0.05). In conclusion, we think that hypercapnia may be reversible in patients admitted with hypercapneic acute COPD attack when PaCO2, SaO2 and BUN levels are high and P(A-a)O2 levels are low, and patients with PaCO2 levels higher than 60 mmHg may benefit much from medical treatment.
Özet
Hiperkapni, kronik obstrüktif akciğer hastalığı (KOAH)'nın akut atağında sık görülür ve bazı olgularda reversibldir. Bu çalışma KOAH akut atağı ve hiperkapni ile başvurmuş, PaCO2'si 60 mmHg üzerinde olan KOAH'lı hastaların klinik ve laboratuvar özelliklerini araştırmak amacıyla yapılmıştır. KOAH akut atağında hiperkapnisi olan (PaCO2 > 50 mmHg) 40 hastadan, PaCO2'de medikal tedavi ile %15 ve üzerinde azalma olanlar grup 1 (n= 16); diğer hastalar grup 2 (n= 24) olarak sınıflandırıldı. Aynı hastalarda başka bir sınıflama, grup A (PaCO2$geq$ 60 mmHg, n= 17) ve grup B (PaCO2 0.05). Grup 1 'de; PaCO2, oksijen satürasyonu (SaO2) ve BUN düzeyleri yüksek, alveolo-arteryel oksijen gradienti (P(A-a)O2) düşük bulundu (p 0.05). Grup A'da; grup B'ye göre pH ve BUN değeri daha düşük ve P(A-a)O2 daha yüksekti (p< 0.05). Grup A'daki hastaların 4'ünde mekanik ventilasyon gerekti, 2 hasta kaybedildi (p< 0.05). Bu çalışmanın sonucunda, KOAH akut atağında hiperkapni ile başvuran hastalarda; PaCO2, SaO2 ve BUN düzeyleri yüksek, P(A-a)O2 düşük olanlarda, hiperkapninin reversibl olabileceği, PaCO2 düzeyi 60 mmHg'dan yüksek hastaların da medikal tedaviden büyük oranda fayda görebileceği kanısına varıldı.