Acid–base balance, serum electrolytes, and need for noninvasive ventilation in patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease

Abstract

Context Chronic obstructive pulmonary disease (COPD) is a common disease with major morbidity and mortality. Hypoventilation occurring with hypercapnia of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) worsens respiratory acidosis in patients. In these patients, acid–base (AB) balance and electrolytes are closely related and affect the patient outcome. Noninvasive ventilation (NIV) use in the management of acute exacerbation improves patients’ respiratory function and decreases complications. Aim To detect the effect of AB and electrolyte disorders in patients with hypercapnic COPD exacerbation, and the effect of the treatment type on the AB and electrolyte disorders. This is a prospective study conducted in the Chest Department of Menoufia University Hospital. Patients and methods We analyzed 110 patients admitted to the Chest Department of Menoufia University Hospital for hypercapnic AECOPD. On admission, all patients underwent history taking, full examination, and arterial blood gas analysis and received oxygen with nasal cannulae or a venturi mask to preserve normal oxygen saturation, as well as received pharmacological treatment. NIV was started when patients had severe dyspnea, increased work of breathing, and respiratory acidosis despite optimum management. Results Based on arterial blood gas finding, we categorized our patients into three main groups: group A had 61 patients with compensated respiratory acidosis; group B had 28 patients with respiratory acidosis+metabolic alkalosis; and group C had 21 patients with respiratory acidosis+metabolic acidosis. A total of 56 patients received pharmacological therapy, and 54 also needed NIV. The use of NIV support was lower in the patients belonging to group A than in those belonging to groups B and C (25.9 vs. 40 and 33.3%, respectively; P<0.001). Conclusion AB balance greatly affects the treatment of patient with AECOPD. The combined metabolic and respiratory acidosis increases the need of NIV and its failure.

Keywords

• chronic obstructive pulmonary disease
• hypercapnia
• noninvasive ventilation