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Objective: To evaluate the predictive value of maximum inspiratory pressure (MIP) besides rapid and shallow breathing index (RSBI) in the weaning of chronic obstructive pulmonary disease (COPD) patients. Material and Methods: Fifty-six COPD patients with acute exacerbation and type II respiratory failure requiring invasive mechanical ventilation for more than 24 hours were enrolled in this study. Extubation was planned if the patients tolerated pressure support mode for at least two hours and spontaneous breathing during a 30 minutes T-piece trial. Breathing frequency, exhaled tidal volume, rapid and shallow breathing index (RSBI), minute ventilation (Vmin), MIP and vital capacity measurements were recorded prior to extubation. Patients were divided into two groups according to weaning success (WS) and failure. WS was defined as 48 hours of independence from mechanical ventilation after extubation. Results: Although RSBI values between two groups were not significantly different, there were statistically significant differences between the two groups in terms of MIP (30 vs 18 cmH2O; p= 0.008) and Vmin (10.40 vs 8.25; p= 0.032). Patients with a MIP value greater than or equal to 25 cm H2O had greater WS when compared to those with values lower than 25 cm H2O. Conclusion: RSBI alone seems not reliable enough to predict weaning outcome in COPD patients with type II respiratory failure due to acute exacerbation. Supported with MIP, better results may be achieved to predict weaning outcome.

Totally 48 cases with diagnosed as community-acquired pneumonia who were treated in intensive care units of two different university hospital included to the study. The mean age of cases was 67.8, 29 were males and 19 females. Glasgow Coma Score (GCS), Acute Physiology Assesment and Chronic Health Evaluation II (APACHE II), Pneumonia Severity Index (PSI) and Sequential Organ Failure Assessment Score (SOFA) of 46 cases were determined. The most common comorbid disease was cerebrovascular disease. We determined that microbiological tests were made in 30 cases and pathogen agent was established in 7 cases of them. The mean lenght of stay in hospital and intensive care unit were 16.1 days and 8.8 days respectively. The mean GCS was 11.4, the mean PSI was 130.7 and 38 cases were in high risk classes. The mean APACHE II and SOFA scores were 20.7 and 4.4 respectively. We determined that hypotension and intubation increased the mortality risk. The mean blood urea nitrogen, %PNL and respiratory rate were higher in cases who were died. The mortality rate in group 3b and group 4 were respectively 41.2% and 44.0%. Totally 20 (41.7%) cases died.

Background: Noninvasive ventilation (NIV) is being increasingly used in hypercapnic chronic obstructive pulmonary disease (COPD) patients but the most appropriate ventilation mode is still not known. Objectives: The aim of this study was to investigate if assisted pressure-controlled ventilation (APCV) can be a better alternative to pressure-support ventilation (PSV) for NIV in COPD patients with acute hypercapnic respiratory failure (AHRF). Methods: In this prospective randomized study, we evaluated the early effects of noninvasive APCV and PSV in 34 consecutive COPD patients with AHRF. Patients were randomized into 1 of the 2 modes, and respiratory and hemodynamic values were compared before and after 1 h of NIV. Results: Baseline values did not differ between the 2 groups. There were significant improvements in partial arterial carbon dioxide pressure and pH levels in the APCV group when compared with baseline (p < 0.05). Cardiac output and cardiac index decreased in both groups (p < 0.05) but more significantly in the PSV group (p < 0.0001). The decreases in stroke volume index and increases in arterial oxygen content after NIV were also considerable in both groups (p < 0.05). Central venous pressure and systemic vascular resistance index values increased notably only after PSV (p < 0.05). Conclusions: From these data, we deduce that APCV can be a better alternative to PSV for NIV in COPD patients with AHRF owing to its more beneficial physiological effects.