DOI: http://dx.doi.org/10.18203/2349-3259.ijct20181740

Effectiveness of non-invasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease

Bhavani Mohan Raju, Sushma Jotkar, Prathyusha M., Shraddha Goswami, Mukesh Dube, Abhishek Singh

Abstract


Background: In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation. The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.

Methods: In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unit during 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.

Results: Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group.

Conclusions: NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis.


Keywords


Noninvasive ventilation, Pulmonary disease, Chronic obstructive

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References


Ko BS, Ahn S, Lim KS, Kim WY, Lee YS, Lee JH. Early failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute hypercapnic respiratory failure. Internal Emergency Med. 2015;10:855-60.

Stefan MS, Nathanson BH, Higgins TL, Steingrub JS, Lagu T, Rothberg MB, et al. Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Critical Care Med. 2015;43:1386-94.

Kumar A, Kumar A, Rai K, Ghazal S, Rizvi N, Kumar S, et al. Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. J Acute Dis. 2015;4:44-7.

Esteban A, Frutos F, Tobin MJ, Alia I, Solsona JF, Valverdu I, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332:345–50.

Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993;341:1555-7.

Pacilli AM, Valentini I, Carbonara P, Marchetti A, Nava S. Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure. BioMed Res Int. 2014;2014:976783.

Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C, Thille AW. Noninvasive ventilation for acute hypercapnic respiratory failure:intubation rate in an experienced unit. Respir Care. 2013;58(12):2045-52.

Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, et al. Noninvaisvevs conventional mechanical ventilation in patients with obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. 2002;28(12):1701-7.

Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison on Noninvasive Positive Pressure Ventilation with standard medical therapy in Hypercapnic Acute respiratory Failure. Chest. 1998;114;1636-42.

Agarwal R, Gupta R, Aggarwal AN, Gupta D. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other Causes: Effectiveness and predictors of failure in a respiratory ICU in North India. Int J COPD. 2008;3(4):737-43.

Barbe F, Togores B, Rubi M, Pons S, Maimo A, Agusti AG. Non- invasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J. 1996;9(6):1240–5.

Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med. 1995;151(6):1799–806.

Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003;326(7382):185.

Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003;138(11):861–70.