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The Rescue Effect of LABA/ICS on Facilitating Weaning in Patients with Prolonged Mechanical Ventilation
以LABA/ICS協助長期呼吸器依賴病患脫離呼吸器的成效
並列摘要
Objective To investigate the use of long-acting β2 agonists (LABA)/inhaled corticosteroids (ICS) combination to facilitate weaning in chronic obstructive pulmonary disease (COPD) patients with prolonged mechanical ventilation.Materials and Methods We retrospectively reviewed data from patients receiving LABA/ICS in respiratory care ward of Veteran General Hospital, Chiayi branch from Oct, 1 to Dec, 31, 2011. The demographic data, nutrient parameters, and airway dynamic parameters were recorded. Then, their routine weekly checked data after the use of LABA/LCS four puff twice a day were analyzed, including secretion quantitative scores, airway resistance, incidence of pneumonia, and weaning status.Results A total of 19 male patients were enrolled. The mean age was 81.1±7.6 year-old, duration of ventilator used was 198.7±254.9 days, and rapid shallow index was 122.0±40.0 bpm/L. Firstly, we found their baseline incidence of ventilator associated pneumonia (VAP) was high (0.82± 0.75 times/month). Besides, these patients were obviously in the inflammatory status with high C-reactive protein (6.8±6.0 mg/dL) and reversed albumin/globulin ratio, and chronic wasting status with low albumin (2.8±0.5 mg/dL), body mass index (19.8±3.8 m2/kg), mid-arm circumference (24.2±3.3 cm), and mid-thigh circumference (38.9±7.9 cm) despite of adequate feeding calories (1821.0±199.0 Kcal) as well as normal pre-albumin (21.8±31.0 mg/dL). After each use of LABA/ICS, their airway resistance decreased for 16.3±15.2% temporally. Moreover, we found that the airway secretion quantitative scores decreased gradually, and the frequency of VAP also significantly decreased from 0.82±0.75 to 0.56±0.55 times/month. Finally, three patients were weaned with the cumulative weaning rate 18.5%, which is obviously higher than the average 5% weaning rate of respiratory care ward in Taiwan.Conclusions The use of LABA/ICS in COPD patients with prolonged mechanical ventilation decreases airway resistance, secretion quantitative scores, the incidence of VAP and may facilitate weaning. Further studies are needed to explore its role on pulmonary and systemic inflammation.