Non-invasive ventilation with autotitrating EPAP maybe confirm successful likelihood of extubation for COPD patients with ST-segment elevation myocardial infarction

Background: Noninvasive ventilation (NIV) with autotitrating EPAP to extubation in COPD with ST-segment elevation myocardial infarction(STEMI)has rarely been assessed. Objectives: To evaluate the role of NIV mode with autotitrating EPAP in decreasing reintubation after extubation and improving patient-ventilator synchronization, for COPD patients with STEMI. Methods: A prospective randomized controlled study, 52 elderly COPD patients with STEMI after weaning/extubation were enrolled (myocardial enzymes was normal but NT-proBNP≥1800pg/ml).Auto-EPAP group(26 cases)：AVAPS-AE(average volume assured pressure support autotitrating EPAP) mode, maximumEPAP=15cmH2O, minimum EPAP=5cmH2O, IPAP:12～20cmH2O, FiO2:50%-65%, Rate=3cmH2O/min, tidal volume depending on BMI. The same parameters above were adopted in fixed-EPAP group except the EPAP level(EPAP=8cmH2O, which equals that in pre-extubation). Results: Reintubation rates within 14 days were 15.3% and 3.8% in fixed-EPAP and auto-EPAP group respectively (p<0.05).Compared with fixed-EPAP group, a higher VAS score (p<0.001), lower incidence of patient-ventilator asynchrony, abdominal distension, lower occurrence of angina pectoris in auto-EPAP group(p<0.005). There was a greater decrease in PCO2 at 1st hour postextubation than in fixed-EPAP group(p<0.01);no difference in PH at the 48th hour postextubation(p>0.05). Conclusions: This finding suggest that the EPAP levels in NIV to extubation for COPD patients with STEMI should be a varying range rather than a fixed and strict parameter.AVAPS-AE mode maybe more likely to improve successful likelihood of extubation and patient-ventilator synchronization.