Effectiveness of non invasive positive pressure ventilation in chronic obstructive pulmonary disease patients

Abstract

27 patients diagnosed as chronic obstructive pulmonary disease (COPD) came with acute hypercapnic respiratory failure due to COPD and met the inclusion and exclusion criteria. They were managed by non invasive positive pressure ventilation (NIPPV). 21 cases showed success and 6 cases showed failure and were put on invasive mechanical ventilation within the first 24 h. It was shown that before initiation of NIPPV, the failed cases had significantly higher Body Mass Index (BMI) 34.7 compared to 28.1 in successful cases and significantly lower pH 7.20 ± 0.05 compared with 7.27 ± 0.04. After 1 h of initiation of NIPPV, the successful group showed improvement regarding pH and PaCO 2 , while the failed group showed worsening of the same parameters, with a significant difference (p value <0.001, 0.005), respectively. After 4 h, there was improvement in both groups regarding pH which reached normalization in the successful group, PaCO 2 , and PO 2 , with no statistical significant difference. There were significant differences in the respiratory rate (p value < 0.001), and the expiratory positive airway pressure (EPAP) (p value 0.024) between the two groups. Thus we can conclude that the use of NIPPV in such patients can be successful in around 78% of cases, however failure can be predicted by high BMI, initial lower pH and higher PaCO 2 , insignificant response to NIPPV after 1 h. They also show increased respiratory rate and need for higher expiratory positive airway pressure.

Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure Secondary to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…NIPPV-failed patients stayed longer in ICU, had higher ICU and hospital costs, and higher in-hospital mortality [20]. Soliman and colleagues reported a 28.5% failure rate of NIPPV and immediate intubation in AECOPD patients at 24 hours from the initiation of therapy [21]. This is comparable to our results (30%) at 24 hours.…”

“…This is comparable to our results (30%) at 24 hours. They predicted NIPPV failure in patients with high BMI, lower initial pH, increased RR, higher PaCO2, and insignificant response to NIPPV after one hour [21].…”

Effectiveness and Outcomes of Noninvasive Positive Pressure Ventilation in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…Similarly, a study in Egypt documented the success rate of NIPPV at 76% [15]. The result of the present study displayed a higher success rate as compared to the reported earlier studies, ranging between 50% and 80% [16,17]. In addition, NIPPV is effective, with a success rate of 89% in COPD subjects with respiratory acidosis with an arterial pH of 7.22 [18].…”

Experience With Non - Invasive Ventilation in Type Ii Respiratory Failure at Department of Pulmonary Medicine, Kurnool Medical College, Kurnool

“…14,15 (Table 1) The present study group has a male preponderance (36/40) of 90% similar to other studies. 15,16,17 ( Table 2). The most common indication of NIV in our Study was acute exacerbation of chronic obstructive pulmonary disease (AE-COPD)90 % (Table 3) as in other studies 14,15,18 NIV was successful in 83.3% of patients in our study cohort of Acute exacerbation of COPD.…”