Impact de la morphine sur le taux d’échec précoce de ventilation non invasive des insuffisances respiratoires aiguës : étude préliminaire rétrospective aux urgences

Abstract : Background. The delivery of low doses of morphine can be done as a second line therapy in acute respiratory failure. We tried to evaluate the impact of this therapeutic for patients admitted for hemodynamic Acute Pulmonary Edema or Acute Exacerbation of COPD (AECOPD) and treated with non invasive ventilation. Methods. We realized a retrospective and exploratory study from a data base extraction of the emergency department in the hospital CHU de Grenoble. Primary endpoint was the rate of NIV failure and secondary endpoints were based on the subgroup analysis according to diagnosis and blood gas evolution. Results. Fifty patients were included after admission between the 01/01/2008 and the 06/30/2017. The rate of NIV failure was not different between the two groups (35% in the group without morphine, 26% in the group morphine, p=0,50). Rate of NIV failure was neither different in subgroup analysis. The blood gas analysis showed a trend towards an increasing pH (0,07 versus 0,05; p=0,22) and a decreasing PaCO2 (-1,02 kPa versus -0,43 kPa ; p =0,06) more important in the morphine group. Conclusion. The delivery of morphine does not seem to be associated with an increased risk of respiratory decline for patients treated by NIV for acute respiratory failure in the emergency department. A prospective study is necessary to better measure the effects of morphine in this clinical situation.
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Master Thesis
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Gaëtan Bouillard. Impact de la morphine sur le taux d’échec précoce de ventilation non invasive des insuffisances respiratoires aiguës : étude préliminaire rétrospective aux urgences. Médecine humaine et pathologie. 2018. ⟨dumas-01926859⟩

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