Publication:

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

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.