Use of Non Invasive Ventilation in Patients with Respiratory Failure in Nepal

Abstract

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59

Serial Arterial Lactate Clearance and Outcome in Patients with Cardio-respiratory Insufficiency Presenting in Emergency Ward at Tertiary Level Hospital

“…The mean age of cardio respiratory insufficient patients in our study was 57.42±18.945 years which was lower than [1,3] and higher than 4 . In our study Male: Female ratio was 1:1.3 which was as similar as most of the studies [1,[3][4][5][6]. In our study the most frequent co-morbidities were COPD 19 cases (25.7%) followed by heart failure 14 cases (18.9%) & coronary artery disease 14 cases (18.9%) other study also showed similar results [3,4].…”

Outcome of non-invasive ventilation (NIV) among patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD).

“…Pnadey et al 10 reported 96.4% success rate in their study at 12 hours after NIV. Our study results are in compliance with that of those reported by Pnadey et al10 Success rate was stratified with regards to gender, age, BMI and duration of disease and p values calculated were found to be p=1.00, p= 0.591, p=0.026 and p=0.606 respectively.The patients with type II respiratory failure due to acute exacerbation of COPD benefited significantly with the use of NIV. Being a cost effective as well as safe mode of treatment, it may be employed in patients with type 2 respiratory failure due to COPD on priority basis.…”

“…NIMV may not be regarded as an alternate for intubation and invasive mechanical ventilation especially when latter is obviously more appropriate 8 as NIMV failure rates among respiratory failure patients of COPD has been shown to be 5 -40 %. 9 In a recent study conducted by Pnadey, et al 10 in Nepal reported twelve hours after bi-level ventilation, 78.7% patients had normal pH and 42.8% had pCO2 above 60 mm Hg showing successful in 27 patients (96.4%).…”

Outcome of Non-Invasive Ventilation in Patients of Acute Respiratory Failure.

“…Twelve hours after bi-level ventilation, only 21.3% had pH<7.35 and 42.8% had pCO2 above 60 mm Hg. NIV was successful in 27 patients (96.4%) 5. Whereras in our study ABG during admission pH ≤ 7.26 (range 7.11-7.39) Vs pH ≤ 7.2 (range 7.06-7.41), pCO2 ≥73.35 (54-127.5) Vs pCO2 ≥ 83.6 (29.5-105.9) among NIV success group and failure group respectively.Limitations of our study are the relatively small sample size and this was an observational study.…”

“…4 Pandey R et al study revealed that out of 28 patients, 27 received bi-level and most common cause was chronic obstructive pulmonary disease with type 2 respiratory failures in 67.8%. 5 Rationale of this study was to see the effectiveness of NIV in ARF patients despite any cause, stay of ICU duration and its outcomes and failure rate of NIV.…”