Predictive Factors for the Effect of Treatment by Noninvasive Ventilation in Patients with Respiratory Failure as a Result of Acute Exacerbation of the Chronic Obstructive Pulmonary Disease

Abstract

BACKGROUND:Noninvasive mechanical ventilation (NIV) applies ventilator support through the patient’s upper airway using a mask.AIM:The aim of the study is to define factors that will point out an increased risk of NIV failure in patients with exacerbation of Chronic Obstructive Pulmonary Disease (COPD).PATIENTS AND METHODS:Patients over the age of 40, treated with NIV, were prospectively recruited. After data processing, the patients were divided into two groups: 1) successful NIV treatment group; 2) failed NIV treatment group.RESULTS:On admission arterial pH and Glasgow coma scale (GCS) levels were lower (pH: p < 0.05, GCS: p < 0.05), and Acute Physiology and Chronic Health Evaluation II (APACHE) score and PaCO2 were higher (p < 0.05) in the NIV failure group. Arterial pH was lower (p < 0.05) and PaCO2 and respiratory rate were higher (p < 0.05) after 1h, and arterial pH was lower (p < 0.05) and PaCO2 (p < 0.05), respiratory and heart rate were higher (p < 0.05) after 4h in the NIV failure group.CONCLUSION:Measurement and monitoring of certain parameters may be of value in terms of predicting the effectiveness of NIV treatment.

Effectiveness assessment of a guideline based protocol for ventilatory support management of COPD exacerbations in an emergency department

“…The presence of tachycardia at admission might represent a possible marker of NIPPV failure and deserves further investigation. Finally, low pH value at admission, usually identified as NIPPV failure predictor 19 , 24 was not a significant independent predictor in our multivariate analysis, in accordance with another study showing that ECOPD with severe acidosis (pH ≤ 7.25) could be successfully treated with NIPPV at intermediate care units. 25 …”

“…Although some seminal pioneer RCTs demonstrating the clinical benefits of noninvasive ventilation in ECOPD did not show a significant difference in PaCO 2 reduction compared to standard therapy, 6 , 7 other studies have demonstrated a significant higher PaCO 2 reduction associated with NIPPV. 5 , 8 Accordingly, the overall combination of seminal RCTs 18 and current observational studies 19 , 24 demonstrated higher PaCO 2 values after 1 h of noninvasive ventilation in the usual medical care group and in the group who subsequently needed IMV, respectively. In fact, the optimal threshold identified in the present study to predict NIPPV success resembled the ∼9 mmHg difference in PaCO 2 reduction between groups ( i.e .…”

“…The identification of predictors of NIPPV failure is not a new concept, and it has been the focus of several previous works resulting in variable findings. 16 , 18 , 22 , 23 , 24 …”

Immunopathological and Modulatory Effects of Cag A+ Genotype on Gastric Mucosa, Inflammatory Response, Pepsinogens, and Gastrin-17 Secretion in Iraqi Patients infected with H. pylori

“…A sterile flexible endoscope was introduced for a full investigation of stomach and duodenum after topical pharyngeal anaesthesia for overnight fasted Patients [ 4 ]. Any congested, inflamed or erosive lesions were picked via sterile biopsy forceps.…”

“…H. pylori colonisation of gastric tissue induces recruitment of inflammatory cells to the infected gastric epithelium and releasing of virulence factors from the bacteria as opposite reaction [ 2 ]. Gastritis induces disruption of acid secretion depending on the predominant location in the stomach, antrum or corpus [ 3 ] [ 4 ]. The gastroduodenal response to chronic H. pylori infection is characterised by infiltration of plasma cells, lymphocytes, neutrophils, and monocytes into gastric mucosa [ 2 ].…”